An inertial sensor-based protocol for spinal range of motion measurements.

To develop a protocol for assessing spinal range of motion using an inertial sensor device. The baseline error of an inertial sensor was assessed using a bicycle wheel. Nineteen healthy subjects (12 females and 7 males, average age 18.2 ± 0.6 years) were then prospectively enrolled in a study to assess the reliability of an inertial sensor-based method for assessing spinal motion. Three raters each took three measurements of subjects' flexion/extension, right and left bending, and right and left rotation. Afterwards, one trial from each set of measurements was excluded. Correlations and the ICC (3,1) were used to assess intra-rater reliability, and ICC (3,2) was used to assess inter-rater reliability of the protocol. The baseline error of the sensor was 1.45°. Correlation and ICC (3,1) values for the protocol all exceeded 0.888, indicating high intra-rater reliability. ICC (3,2) values for the protocol exceed 0.87, indicating high inter-rater reliability. Our study presents both a paradigm for assessing the baseline error of inertial sensors and a protocol for assessing motion of the spine using an inertial sensing device.

Anesthetic considerations for a novel anterior surgical approach to pediatric scoliosis correction.

BACKGROUND: Idiopathic scoliosis is a condition that may require surgical correction. Limitations of previous surgical modalities, however, created the need for novel methods of repair. One such technique, a newer form of anterolateral scoliosis correction, has shown considerable promise, which our center has had substantial experience performing. AIM: In this article, we present the case details of our first 105 patients for the purposes of describing the evolution and details of the anesthetic management and considerations for this procedure. METHODS: A retrospective review of medical records for 105 patients undergoing anterolateral instrumentation procedure for idiopathic scoliosis correction done at a single institution from May 2014 to June 2016 was performed. The details of perioperative management as well as surgical technique were reported for all patients. RESULTS: The mean age for patients was 14.8 years (range 10-18); the mean weight was 49.9 kg (range 25-82). Unilateral procedures were performed on 46.7%, with bilateral and hybrid procedures performed on 50.5% and 4.7%, respectively. The median number of levels corrected was 8 (interquartile range [IQR] 7-9) for unilateral, right 7 (IQR 6-7) and left 5 (IQR 4-5) for bilateral, and 4 (IQR 4-4.5) for hybrids. The average estimated blood loss (EBL) was 310 mL±138, with cell salvaged blood transfused in 61% of patients, and allogenic blood transfusion required in only two patients. CONCLUSIONS: The described anesthetic and analgesic management provides a framework for delivering perioperative care for this challenging procedure, which is gaining popularity as a modality for scoliosis correction.

Combined effects of neurotrophin secreting transplants, exercise, and serotonergic drug challenge improve function in spinal rats.

OBJECTIVES: To determine the effects of neurotrophin-secreting transplants combined with exercise and serotonergic drug challenges on recovery of hindlimb function in rats with midthoracic spinal cord transection injuries. METHODS: Spinalized animals received transplants of fibroblasts genetically modified to express brain-derived neurotrophic factor and neurotrophin-3 and daily cycling exercise. Hindlimb movement in an open-field test (BBB) was scored weekly. Serotonin agonists were used monthly to further stimulate motor function. Axonal growth was quantified in the transplant and at L5 using immunocytochemical markers. Weights of hindlimb muscles were used to assess muscle atrophy. RESULTS: Neurotrophin-secreting transplants stimulated axonal growth, and cycling prevented muscle atrophy, but individual treatments did not improve motor scores. Combined treatments resulted in improvements in motor function. Serotonergic agonists further improved function in all groups, and transplant groups with exercise achieved weight-supporting levels following drug treatment. CONCLUSION: Combined treatments, but not individual treatments, improved hindlimb function.

Neurologic complications after lumbar spine surgery.

With the increasing complexity and number of lumbar spine operations being performed, the potential number of patients who will sustain perioperative complications, including those that involve neural structures, has also increased. Neurologic complications after lumbar spine surgery can be categorized by the perioperative time period during which they occur and by their mechanism of injury. Although the overall incidence of neurologic complications after lumbar surgery is low, the severity of these injuries mandates careful preoperative planning, awareness of risk, and meticulous attention to perioperative details.

Innervation of the human vertebral body: a histologic study.

The histology of 69 human vertebral bodies from 23 individuals was studied by hematoxylin and eosin staining using a technique that allowed the creation of complete, large histologic sections of individual vertebral bodies. Particular attention was directed toward the documentation of intraosseous nerves. The vertebral bodies were dissected free of soft tissue, and then sectioned using a diamond wafering saw into 3-mm sagittal segments. Sections were then decalcified and whole-mounted in paraffin blocks before tissue sectioning using a very-large-format microtome. One hundred thirty-eight tissue sections were prepared for evaluation. Neurovascular bundles and intraosseous nerves were routinely identified within human vertebral bone. Nerves were noted to enter the vertebral body via the centrally located posterior vascular foramen and were found to accompany the basivertebral vessels. Branches from these nerves coursed to both central and peripheral areas of the vertebral body. Nerves were also documented that entered the vertebral body by penetrating the anterior cortex to course into the marrow. Although previous studies have documented nerves within long bones, and others have described the histology of the intervertebral disc and associated soft tissues, previous literature that documents the innervation of the human vertebral body has been very sparse. The documentation of nerve tissue within normal human vertebrae further supports the proposed role of neuronal factors in the regulation of bone physiology. Furthermore, it is possible that such intraosseous nerves may play a role in the clinical problem of back pain.

Regional variation in vertebral bone density and trabecular architecture are influenced by osteoarthritic change and osteoporosis.

STUDY DESIGN: The effects of age-related osteoarthritic disease and bone loss on cortical and trabecular bone density in the human spine were analyzed. Changes were quantified by a new method of computed quantitative radiography. Using this method, the relative losses of bone mineral from specific areas and the specific redistribution of bone within vertebrae as a function of age-related bone loss and osteoarthritic change were determined. OBJECTIVES: To quantify the effects of age-related bone loss and osteoarthritic disease on cortical and trabecular density in the human spine by the use of a new method of computed quantitative radiography. SUMMARY OF BACKGROUND DATA: To the authors' knowledge, osteoarthritic and age-related changes resulting in the relative loss of bone mineral from specific areas within vertebrae have never been quantitatively studied. METHODS: Seventy-four vertebrae were obtained from 23 normal, human subjects at autopsy. Vertebral bodies were measured by dual-energy x-ray absorption, and then sectioned for analysis by computerized quantitative radiography. Attention was focused on overall bone density, regional cancellous bone density, and cortical bone density (anterior cortex, superior, and inferior endplates) for both mid-sagittal and para-sagittal sections. One hundred forty sections were so analyzed. RESULTS: Quantitative radiography demonstrated previously undescribed, well defined patterns of cortical and trabecular architecture and bone density within vertebral bodies that were uniform among vertebrae, but strongly influenced by osteoarthritic change and bone loss. These changes were neither detected nor documented by dual-energy x-ray absorption. CONCLUSIONS: Understanding the patterns of bone lose, and knowing how osteoarthritic change affects normal bone loss yields insight into the pathophysiology of the aging process and osteoarthritic disorders. Knowledge of the variations in density and microanatomy within vertebrae may improve techniques of internal fixation and designs of spinal implants, and may help to clarify the pathogenesis of clinical problems such as fractures.

Pitfalls in the measurement of bone mineral density by dual energy x-ray absorptiometry.

STUDY DESIGN: Fifty-three human thoracic and lumbar vertebrae were analyzed by dual energy x-ray absorptiomety to obtain projectional (g/cm2) and volumetric (g/cm3) bone mineral density. OBJECTIVES: To determine the effect of volume on the measurement of bone mineral density by DEXA. SUMMARY OF BACKGROUND DATA: Despite the widespread use of dual energy x-ray absorptiomety to measure bone mineral density expressed as grams per projectional unit area (g/cm2), the effect of volume has been ignored in many published biomechanical studies. METHODS: Projectional bone mineral density (g/cm2) of fifty-three human vertebrae was obtained by dual energy x-ray absorptiometry measurement. This was compared to bone mineral density expressed as grams per unit volume. RESULTS: Many specimens with near equal projectional bone mineral density were demonstrated to have significantly different true densities when measured by dual energy x-ray absorptiomety in grams per unit volume. The difference in true bone mineral density for these specimens ranged from 24.1% to 139%. CONCLUSION: The effect of volume on bone mineral density data based on projectional areas can cause very significant perturbations of the data in biomechanical studies.

gamma-Aminobutyric acidA receptor heterogeneity in rat central nervous system: studies with clonazepam and other benzodiazepine ligands.

The properties of [3H]clonazepam, [3H]diazepam and [3H]zolpidem (N,N,6[trimethyl-2-(4-methyl-phenyl)imidazo[1,2-a]pyridine-3-acetamide hemitratrate) binding to synaptic membranes of cerebellum, cortex, olfactory bulb, striatum and spinal cord of rat were compared to the binding properties of [3H]flunitrazepam, [3H]flumazenil and [3H]midazolam. In the cerebellar, cortical and olfactory bulb membranes, the density of high-affinity binding sites of all these tritiated benzodiazepine (BZ) ligands is almost identical. In contrast, in the striatum, the density of [3H]clonazepam and [3H]zolpidem binding sites is approximately 60 and 30%, respectively, of the density of [3H]diazepam, [3H]flunitrazepam or [3H]flumazenil sites. In spinal cord membranes, the number of high-affinity binding sites of [3H]clonazepam and [3H]zolpidem is less than 20% of the number of binding sites for [3H]diazepam, [3H]flunitrazepam, [3H]flumazenil and [3H]midazolam. Moreover, the displacement of [3H]flunitrazepam from spinal cord membranes by clonazepam and zolpidem was characterized by high IC50 values and Hill slopes significantly less than 1. Because [3H]BZ ligand binding in the spinal cord is enhanced by gamma-aminobutyric acid (GABA), these data suggest that different regions of the rat central nervous system may contain different GABA-BZ receptor subtypes. The different pharmacological properties of clonazepam, diazepam and zolpidem (i.e., regarding their ability to enhance bicuculline seizure threshold, to decrease locomotor activity, to induce ataxia or to elicit anticonflict action) further support the concept that in the rat central nervous system preferential occupancy of heterogeneous GABAA receptors by these drugs can be related to their effects on behavior.