. § Electrophysiological Assessment Our laboratory has recently developed a technique for electrophysiological assessment of spinal cord function involving the combined recording of motor evoked potentials (MEP's) and somatosensory evoked potentials (SSEP's). 8, 9 However, this method involved invasive direct recording from the spinal cord using microelectrodes, a technique that causes significant mortality in rats with chronic spinal cord injuries. Hence, during the course of the present experiment, the method was modified by eliminating invasive recording from the cord so that the
Michael G. Fehlings, Charles H. Tator and R. Dean Linden
Charles H. Tator and Michael G. Fehlings
, Keller S , et al : Naloxone and experimental spinal cord injury: part 2. Megadose treatment in a dynamic load injury model. Neurosurgery 19 : 909 – 913 , 1986 Black P, Markowitz RS, Keller S, et al: Naloxone and experimental spinal cord injury: part 2. Megadose treatment in a dynamic load injury model. Neurosurgery 19: 909–913, 1986 19. Blight AR : Cellular morphology of chronic spinal cord injury in the cat: analysis of myelinated axons by line-sampling. Neuroscience 10 : 521 – 543 , 1983 Blight AR
Michael G. Fehlings, Paul R. Cooper and Thomas J. Errico
38 patients. Four patients were lost to follow-up review at 3,5,11, and 16 months; two patients died of chronic medical problems at 4 and 9 months posttreatment. The clinical records and radiographs of all patients in this series were reviewed. All patients were evaluated in the follow-up period by a detailed questionnaire with an assessment of neurological status, neck pain, subjective range of movement, and deformity. Static (anteroposterior and lateral) and dynamic (lateral flexion-extension) radiographs of the cervical spine were obtained. Selected
Michael G. Fehlings and Charles H. Tator
Neurosurg 37 : 591 – 593 , 1972 Brodkey JS, Richards DE, Blasingame JP, et al: Reversible spinal cord trauma in cats. Additive effects of direct pressure and ischemia. J Neurosurg 37: 591–593, 1972 26. Brunette DD , Rockswold GL : Neurologic recovery following rapid spinal realignment for complete cervical spinal cord injury: a review and classification of 22 new cases with details from a case of chronic compression with extensive focal demyelination. J Trauma 27 : 445 – 447 , 1987 Brunette DD, Rockswold GL
Gwen Schwartz and Michael G. Fehlings
chronic hindlimb function following traumatic SCI. 10, 11, 54, 84 Moreover, with fluorescent retrograde tracing we found greater neuron counts and preferential sparing of large-diameter cells in the red nucleus and a trend toward increasing counts of neurons in the raphe, reticular, and vestibular nuclei in rats treated with riluzole. In reports from our laboratory strong associations have been described between the persistence of axons originating from these nuclei and residual hindlimb locomotor function in rats after SCI. 32 In addition, preservation of large
Preneshlin V. Govender, Yoga R. Rampersaud, Lynda Rickards and Michael G. Fehlings
The safety and effectiveness of osteogenic protein (OP)–1 putty (recombinant human bone morphogenetic protein–7) in promoting fusion in complex spinal cases was studied in nine cases.
The authors prospectively evaluated nine patients requiring spinal fusion in whom there were medical risk factors that would inhibit osseous fusion. Intraoperatively the OP-1 putty mixed with autologous bone was placed at the fusion site. Outcome measurement instruments were used to provide information on patient demographics, comorbidities, and pain. The Short Form (SF)–36 questionnaire and Oswestry Disability Index (ODI) were administered pre- and postoperatively. All patients underwent routine radiography of the surgery site during follow-up examination.
The age of the five women and four men ranged from 21 to 74 years (mean height 1.6 m, mean weight 76.7 kg). Risk factors included mucopolysaccharide syndrome, adrenal insufficiency, rheumatoid arthritis with chronic corticosteroid use, morbid obesity, and heavy smoking. Surgery, which consisted of five cervical and four lumbar procedures, including intradural surgery in three patients, was uneventful in all cases without perioperative complication. The follow-up period ranged from 1 to 15 months (mean 5.22 months). The ODI score changed from severe disability (mean 46.89) pre-operatively to minimal and moderate disability (mean 34.56) postoperatively. The SF-36 survey showed overall improved mental and physical health scores. Fusion was present in all patients with greater than 3 months follow up.
The OP-1 putty appears to be safe and effective in promoting spinal arthrodesis in patients in whom adverse medical risk factors exist.
Steven Casha and Michael G. Fehlings
against graft extrusion. Additionally, it is thought to provide rigid immobilization in flexion, extension, torsion, and lateral bending, which may lead to better fusion rates, as expected throughout the skeletal system based on the orthopedic experience. Plating may also be useful in contouring the surgically treated cervical spine to maintain lordosis, and this may decrease the likelihood of adjacent-level degeneration, progressive deformity, and chronic postoperative axial pain. Furthermore, because the plate provides good internal fixation the use of a postoperative
Use of osteogenic protein-1 in patients at high risk for spinal pseudarthrosis: a prospective cohort study assessing safety, health-related quality of life, and radiographic fusion
Invited submission from the Joint Section on Disorders of the Spine and Peripheral Nerves, March 2007
Julio C. Furlan, Richard G. Perrin, Preneshlin V. Govender, Yuriy Petrenko, Eric M. Massicotte, Yoga R. Rampersaud, Stephen Lewis and Michael G. Fehlings
diseases, including bone disease, stroke, inflammatory bowel disease, prostate cancer, and chronic renal disease. 5 , 20 , 22 , 30 , 40 More explicitly, OP-1 plays an important role in bone formation by inducing differentiation of pluripotent mesenchymal cells into active osteoblasts. 32 , 34 Results from animal studies 8 , 10 , 14 , 21 have shown that use of OP-1 can induce a stable, mature, posterolateral spinal fusion mass more rapidly than an autologous bone graft, and the resulting fusion mass may be biomechanically stiffer in the early stages (up to 3 months
W. Bradley Jacobs and Michael G. Fehlings
A nkylosing spondylitis is the major subtype of an interrelated group of seronegative rheumatic spondyloarthritides that also includes psoriatic spondyloarthritis, reactive spondyloarthritis, spondyloarthritis associated with inflammatory bowel disease, and undifferentiated spondyloarthritis. 10 Ankylosing spondylitis primarily affects the axial skeleton (sacroiliac joints and spinal column) and is a chronic lifelong disease that often starts in young adults, with the age at onset being < 30 years in 80% of patients. 18 The usual disease pattern is one
Eftekhar Eftekharpour, Soheila Karimi-Abdolrezaee and Michael G. Fehlings
relative degree of demyelination of spinal cord axons in the chronic stages of SCI. 100 Myelin facilitates fast “saltatory conduction” of action potentials and plays a key role in determining the molecular organization of axons, as has been reviewed previously. 67 Myelinated fibers display a highly organized molecular architecture in which the Na + channels are contained at the nodal area, and Kv1.1 and Kv1.2 K + channel subunits are located under the compact myelin in the juxtaparanodal zones ( Fig. 1 ). The nodal and juxtaparanodal regions are separated by the