Descending tracts and spinal shock in the cat

Schiff-Sherrington phenomenon in a cat with complete spinal cord transection from traumatic dorsocranial luxation of the second lumbar vertebra

A young stray entire female domestic shorthair cat was presented with symmetrical forelimb extensor rigidity, neck hyperextension and hindlimb paraplegia, characteristic of Schiff-Sherrington phenomenon (SSP), within 30 min of a motor vehicle accident. Radiographic and post-mortem studies disclosed complete transection of the spinal cord from traumatic dorsocranial luxation of the second lumbar vertebra, displacement of the sacrum from the ilium, seventh lumbar and first caudal vertebrae and multiple pelvic fractures. Other causes of forelimb extensor rigidity and neck hyperextension such as decerebrate and decerebellate rigidity were excluded by a lack of neurological signs consistent with these entities and unremarkable findings on post-mortem examination of the cranial cavity and brain and histological examination of the cerebrum, brainstem and cerebellum. To the best of the author's knowledge, this is the first report of SSP in the cat outside the experimental arena of decerebrate or non-decerebrate preparations following post-brachial spinal cord transection/cold block.

Developing a predictive model for spinal shock in dogs with spinal cord injury

BACKGROUND

Reduced pelvic limb reflexes in dogs with spinal cord injury typically suggests a lesion of the L4-S3 spinal cord segments. However, pelvic limb reflexes might also be reduced in dogs with a T3-L3 myelopathy and concurrent spinal shock.

HYPOTHESIS/OBJECTIVES

We hypothesized that statistical models could be used to identify clinical variables associated with spinal shock in dogs with spinal cord injuries.

ANIMALS

Cohort of 59 dogs with T3-L3 myelopathies and spinal shock and 13 dogs with L4-S3 myelopathies.

METHODS

Data used for this study were prospectively entered by partner institutions into the International Canine Spinal Cord Injury observational registry between October 2016 and July 2019. Univariable logistic regression analyses were performed to assess the association between independent variables and the presence of spinal shock. Independent variables were selected for inclusion in a multivariable logistic regression model if they had a significant effect (P ≤ .1) on the odds of spinal shock in univariable logistic regression.

RESULTS

The final multivariable model included the natural log of weight (kg), the natural log of duration of clinical signs (hours), severity (paresis vs paraplegia), and pelvic limb tone (normal vs decreased/absent). The odds of spinal shock decreased with increasing weight (odds ratio [OR] = 0.28, P = .09; confidence interval [CI] 0.07-1.2), increasing duration (OR = 0.44, P = .02; CI 0.21-0.9), decreased pelvic limb tone (OR = 0.04, P = .003; CI 0.01-0.36), and increased in the presence of paraplegia (OR = 7.87, P = .04; CI 1.1-56.62).

CONCLUSIONS AND CLINICAL IMPORTANCE

A formula, as developed by the present study and after external validation, could be useful for assisting clinicians in determining the likelihood of spinal shock in various clinical scenarios and aid in diagnostic planning.

Recovery of neuronal and network excitability after spinal cord injury and implications for spasticity

The state of areflexia and muscle weakness that immediately follows a spinal cord injury (SCI) is gradually replaced by the recovery of neuronal and network excitability, leading to both improvements in residual motor function and the development of spasticity. In this review we summarize recent animal and human studies that describe how motoneurons and their activation by sensory pathways become hyperexcitable to compensate for the reduction of functional activation of the spinal cord and the eventual impact on the muscle. Specifically, decreases in the inhibitory control of sensory transmission and increases in intrinsic motoneuron excitability are described. We present the idea that replacing lost patterned activation of the spinal cord by activating synaptic inputs via assisted movements, pharmacology or electrical stimulation may help to recover lost spinal inhibition. This may lead to a reduction of uncontrolled activation of the spinal cord and thus, improve its controlled activation by synaptic inputs to ultimately normalize circuit function. Increasing the excitation of the spinal cord with spared descending and/or peripheral inputs by facilitating movement, instead of suppressing it pharmacologically, may provide the best avenue to improve residual motor function and manage spasticity after SCI.

Tendon reflexes for predicting movement recovery after acute spinal cord injury in humans

OBJECTIVE

Use the tendon reflex to examine spinal cord excitability after acute spinal cord injury (SCI), relating excitability findings to prognosis.

METHODS

We conducted repeated measures of reflex responses to mechanical taps at the patellar and Achilles tendons of the lower limbs, and the wrist flexor tendons of the upper limbs in persons with acute SCI, beginning as early as the day of injury. The single largest EMG response (peak-to-peak) for each site was recorded. Subjects were compared based on level of injury and final neurologic status of lower limb motor function (i.e. absence of any voluntary recruitment in a lower limb muscle: motor-complete; voluntary recruitment in 1 or more lower-limb muscles: motor-incomplete).

RESULTS

We studied 229 subjects with acute SCI. Persons with injury to the cervical or thoracic spinal cord and who were (or became) motor-incomplete showed large tendon responses, even at the time of initial evaluation. In combination with larger tendon response amplitudes, the presence of the 'crossed-adductor' response to patellar tendon taps at the acute stage was highly predictive of functional motor recovery following SCI. In marked contrast, tendon responses were small (e.g. < 0.1 mV) or absent in persons with acute, motor-complete injury (and which remained motor-complete), and the crossed-adductor response was never seen. Reflex amplitudes and the incidence of the crossed-adductor response increased somewhat over time in persons with motor-complete SCI, but did not approach the values seen in motor-incomplete subjects.

CONCLUSIONS

Taken together, tendon response amplitude and reflex spread were sensitive and specific indicators of preserved supraspinal control over lower limb musculature in subjects with acute SCI. A simple algorithm using these outcome measures predicted a 'motor-complete' status with 100% accuracy, and a motor-incomplete status with accuracy exceeding 91%.

Ischemia-induced delayed-onset paraplegia is accompanied by an unusual form of synaptic degeneration in the lumbosacral segments: an experimental light and electron microscopic study in dogs

We studied the effect of high thoracic aorta cross-clamping, complete transverse section of the spinal cord at Th6 level, and combined hemisection at Th6 level followed later by high thoracic aorta cross-clamping upon the morphology and number of identified presynaptic knobs in lumbosacral segments in dogs. In animals surviving 48-72 hours after high thoracic aorta cross-clamping the occurrence of an unusual form of boutons accompanied by periboutonal halo in L3-S1 segments was found. According to the bouton size and light as well as electron microscopic appearance, four types, i.e., light giant (T1), dark enlarged (T2), light giant with periboutonal halo (T3), and giant disintegrating (T4) boutons were detected after 48 and 72 hour reperfusion. The appearance of four boutonal types in the lumbosacral segments is caused by spinal cord ischemia secondary to high thoracic aorta cross-clamping followed by 48 or 72 hour reperfusion. At the end of the sixth reperfusion day no signs of enlarged and giant boutons were detected in L3-S1 segments. A statistically significant increase of enlarged and giant boutons was noted at the end of the third reperfusion day in comparison with 48 hour survival. After spinal cord transection at midthoracic (Th6) level, followed by 72 hour survival, no such unusual synaptic knobs could be found in L3-S1 segments. The laminar distribution pattern of T1-T4 types based on light microscopic analysis and confirmed electron microscopically is characteristic and strictly bound to those spinal cord gray matter layers which serve as main termination sites of the descending cortical, brain stem, as well as long propriospinal projections in the lumbosacral segments (laminae V-VII). A statistically significant increase of enlarged and giant boutons was found in the intermediate zone (lamina VII). Hemisection at midthoracic level (Th6) followed later by 30 minute high thoracic aorta cross-clamping and 48 hour reperfusion caused a marked decrease of enlarged and giant boutons in L3-S1 segments on the hemisectioned side in comparison with the contralateral one. Large amounts of irregularly arranged round vesicles and tubular profiles were disclosed in the boutonal matrix of T1, T3, and T4 types in L3-S1 segments of animals subjected to 30 minute high thoracic aorta cross-clamping followed by 72 hour reperfusion. Accumulation of tubular and membranous materials was invariably seen in the bulbous enlargement of the terminal axonal branch.(ABSTRACT TRUNCATED AT 400 WORDS)

The limitations of the tendon jerk as a marker of pathological stretch reflex activity in human spasticity

The motor disorders associated with human spasticity arise, partly from a pathological increase in the excitability of muscle stretch reflexes. In clinical practice, reflex excitability is commonly assessed by grading the reflex response to a blow delivered to the tendon of a muscle. This is a much simpler response than the complex patterns of activity which may be elicited following muscle stretch caused by active or passive movement. Changes in the biceps brachii tendon jerk response have been followed over the first year after stroke in a group of hemiparetic patients and compared with changes in short and medium latency reflex responses elicited by imposed elbow flexion of initially relaxed spastic muscle and with the development of the late reflex responses which contribute to spastic hypertonia. A progressive increase in tendon jerk responses occurred over the first year following stroke, whereas reflex responses to imposed displacement, in particular the late reflex responses contributing to muscle hypertonia, reached their peak excitability one to three months after stroke, with a subsequent reduction in activity. The tendon jerk reflex therefore provides an incomplete picture of the pathological changes in the reflex responses in spasticity.

Lesions of cat sacrocaudal spinal cord: a minimally disruptive model of injury

As part of our studies of the organization of the cat sacrocaudal spinal cord (S3-Ca7), the portion of the neuraxis that innervates the tail, we have begun to evaluate the behavioral effects of hemisection or complete transection at the level of Ca1. Clinical observations that the tail strongly deviated to the side of a hemisection indicated the presence of an ipsilateral hypertonia. After complete transection of the spinal cord, the tail became ventroflexed in a midline position and exhibited spasticity, i.e., hypertonia, hyperreflexia, and clonus. Bowel and bladder functions and hindlimb gait and reflexes remained intact following either lesion. Quantitative behavioral measures corroborated our clinical observations. With the tail tethered to a force transducer, tail muscle tone was measured after the tail was passively positioned. Following a transection, resistance to dorsiflexion of the tail was greater than resistance to ventroflexion. In addition, tonic deviation of the tail was documented with videotape analysis while cats walked on a plank. Normal cats walked with the tail sharply dorsiflexed and centered. In contrast, the tail deviated ipsilaterally in cats with a hemisection, and the tail was ventroflexed in cats with a transection. These observations indicate that the sacrocaudal spinal cord provides a model with special advantages for investigation of changes in segmental motor functions following spinal cord injury. The effects of lesions on the tail are quantifiable and can resemble that spasticity observed after spinal cord injury in humans. Importantly, minimal effects on locomotive and autonomic functions were observed following hemisection or transection of the sacrocaudal spinal cord.

Correlative electrophysiological and behavioral evaluation following L5 lesions in the cat: a model of spasticity

The present work developed an animal model of hindlimb spasticity by analyzing the electrophysiological and behavioral consequences of L5 spinal cord lesions in cats. In chronically lesioned animals (1 to 6 months), the L7-S1 dorsal roots were stimulated and evoked potentials were recorded from hindlimb flexor and extensor motor nerves. Following lateral hemisection, the monosynaptic responses were 2-5 times larger (for voltage-time integral and for amplitude) on the ipsilateral side than those from the contralateral side or from control animals. Half-widths, rise-times, and latencies of the monosynaptic responses were the same on both sides. Behavioral signs of spasticity, including hypertonia and increased deep tendon reflexes, were displayed from the ipsilateral hindlimb following lateral hemisection. With lateral hemisection or with extensive dorsal quadrant lesions, hopping and proprioceptive placing reflexes were abolished; these behavioral observations impart functional significance to physiological and anatomical studies of a mid-lumbar center considered to be important for movement control. The present model represents the first demonstration of a statistically significant correlation between electrophysiological and behavioral observations of spasticity for animals with a lateral hemisection. These correlations demonstrate the utility of behavioral screening of animals for subsequent neurophysiological analyses. This facilitates the investigation of cellular events underlying spasticity and of strategies for its relief with tissue repair techniques affecting local circuitry involved in spasticity.

Spared-root deafferentation of a cat's hindlimb: hierarchical regulation of pathways mediating recovery of motor behavior

Previous studies showed that after complete hindlimb deafferentation in cats, the ipsilateral descending pathways mediated recovery of overground, goal-directed locomotion and accurate placement of the deafferented limb. In the present study deafferentations sparing one dorsal root (L6) were performed to see if the descending systems would still be responsible for the recovery. The partially deafferented hindlimb is initially impaired in postural reflexes and accurate placement during locomotion but considerable recovery occurs. A similar pattern of severe impairment and subsequent recovery is observed in cats in which the only lesion is L1 hemisection. When a hemisection is added 6 months later to chronic spared-root deafferentation the recovery (from the latter lesion) is temporarily reversed but the animals recover again in a fashion similar to that after hemisection alone. Since there is no recovery of overground locomotion when hemisection is added to complete deafferentation but there is when deafferentation is incomplete, the descending pathways apparently are not responsible for maintaining the recovery when one dorsal root is spared as they are when all are cut. The results suggest that a competitive or hierarchical control over residual systems may regulate recovery of motor function.

Serial recording of reflexes after feline spinal cord transection

Implanted nerve cuff and muscle electrodes were used to serially record reflexes after spinal cord transection in cat. Recording of reflexes, in response to both sensory nerve and to mixed motor and sensory nerve stimulation, was accomplished through 2 months after cord section. Serial recording of afferent and efferent nerve volleys was achieved as well. Serial reflex changes that follow cord transection are described. Reflex amplitude to sensory nerve stimulation increased in two phases. The first increase was noted between 1 and 4 days after cord transection; the second increase was recorded between 2 and 4 weeks. These observations suggest that at least two neuronal mechanisms with distinct temporal courses mediate the appearance of spinal hyperreflexia. The animal model described may be useful for further study of the neuronal mechanisms which underlie the hyperreflexia of spinal cord injury.

Effects of training on the recovery of full-weight-bearing stepping in the adult spinal cat

The effects of ambulatory training on the extent and time course of recovery of weight-bearing-stepping in cats spinalized (T12-T13) as adults were investigated. One month after spinal cord transection, 14 of 16 cats were capable of bearing the full weight of their hindquarters with their hind limbs during stepping on a motor-driven treadmill if the tail was pinched or crimped. Of those 14 cats 8 were assigned to a trained and 6 to an untrained group. Trained cats were subjected to 30 min/day of treadmill exercise, 5 days/week. Training was initiated 1 month posttransection and continued until 5 to 7 months posttransection. Daily records were kept on the treadmill speeds used, the time at each speed, and the number of steps that were not full weight bearing. The number of full-weight-bearing steps times treadmill speed was used as a measure of performance. The tail was crimped whenever necessary, but was required less and less as training progressed. Performance plateaus were reached between 25 and 85 days after initiating training (mean = 48 +/- 22 days). Maximum treadmill speeds increased in untrained cats from 0.075 +/- 0.042 m/s 1 month posttransection to 0.240 +/- 0.042 m/s 5 to 7 months posttransection and those of trained cats increased from 0.079 +/- 0.045 m/s to 0.619 +/- 0.133 m/s during this same period. We conclude that a much larger proportion of adult spinal cats are capable of full-weight-bearing stepping than reported, and that training which emphasizes early tail crimping and complete weight bearing at all times results in marked improvements in the locomotor capacity of the hind limbs.

Induction of spinal seizures by natural stimulation in cats

Transection of the spinal cord of the cat at a thoracic or lumbar level results, after as short a period as 12 days, in a preparation with such altered excitability that repeated natural stimulation of the dermatome just caudal to the transection site will induce, in as short a time as 3 days, seizure discharges. The trigger zone for the seizure spreads to caudal dermatomes when these caudal regions are repeatedly stimulated. The 'typical' T4-T7 seizure is a scratch reflex followed by the tonic-clonic seizure lasting for 20-30 s and ending with a scratch afterdischarge lasting for several minutes. Lower thoracic and upper lumbar seizures consist of tonic-clonic co-contractions of the muscles of the hindlegs, followed by rhythmical stepping movements lasting less than 1 min. Partial dorsal rhizotomy or local Cobalt application to the spinal cord may reduce the threshold for induction of seizure by natural stimulation and local Penicillin application to spinal cord induces seizure discharges similar to those induced by natural stimulation. Retransection of the spinal cord caudally, with elimination of the primary trigger zone, does not abolish the secondarily acquired triggers. The findings suggest that spinal circuits possess the ability to acquire new neuronal patterns of discharge and to transfer them to other more caudal segments.

Restoration of function in external intercostal motoneurones of the cat following partial central deafferentation

The activity of external intercostal motoneurones in the cat was studied under anaesthesia and paralysis before and after partial central deafferentation caused by single or double ipsilateral hemisections of the thoracic spinal cord. The normal efferent inspiratory discharges recorded from external intercostal nerve filaments caudal to the upper lesion were greatly reduced acutely, but activity of approximately normal intensity and phase at eupneoic levels of CO2 was restored within a few days and remained at similar levels for up to two years. The patterns of the restored activity were abnormal, with more discharges of alpha-motoneutrones during expiration than normal and a stronger modulation of the discharges by the respiratory pump than normal. A common abnormal component of the restored activity was a tonic discharge in hypocapnic apnoea, often modulated by the respiratory pump. This activity was never seen in normal animals or in those with acute lesions under similar conditions of anaesthesia. Synchronization of the discharges of alpha-motoneurones caudal to the upper lesion was studied by constructing cross-correlation histograms between paired groups of motoneurones, each group being represented by the discharges in one filament. Synchronization was stronger than normal, usually extending over a time course of +/- 20 to +/- 50 ms (broad-peak synchronization). This synchronization was particularly strong for the discharges in hypocapnic apnoea. We conclude that the restored activity was derived in large part from abnormal tonic (non-respiratory-phased) inputs, partly proprioceptive in origin, probably involving spinal cord interneurones with abnormally synchronized discharges. This conclusion is supported by intracellular measurements including respiratory drive potentials, synaptic noise and average common excitation potentials.

Infant lesion effect: II. Sparing and recovery of function after spinal cord damage in newborn and adult cats

Considerable disagreement exists concerning the degree to which sparing and/or recovery of function occurs following CNS damage at birth rather than in adulthood. To study this question, the spinal cord was hemisected in neonatal and adult cats and the motor behavior of the two groups was compared when the neonatal operates matured and the adult operates recovered. Quantitative analysis of the motor behavior indicated that the effects were not uniform: in some aspects of motor behavior sparing of function was found in neonatal operates; in others, the adult operates displayed performance which was superior to the neonatal group. Both groups exhibited considerable recovery of locomotor function, but adult operates showed greater accuracy of limb placement during locomotion. Furthermore, the neonatal group had some deficits in locomotion and postural reflexes which were not seen at all in adult operates. There were, however, examples of greater recovery in neonatal operates, e.g. in ipsilateral hopping responses and in the reduced hypermetria of the proprioceptive placing reflexes. True sparing of function was manifested by the presence of tactile placing in neonatal operates which was always abolished permanently in adult operates. The characteristics of the performance suggested that although sparing of function had obviously occurred, the response had never matured fully. These results taken together indicate that the relationship between age at the time damage occurs and ultimate outcome in terms of motor behavior is complex: different motor patterns respond differently to the same lesion. True sparing of function may be restricted to motor patterns which are not directly affected by the lesion because they have not yet developed when the lesion is made.

Regional metabolic changes in the spinal cord related to spinal shock and later hyperreflexia in monkeys

The regional metabolic rate for glucose (rMRglu) was studied in macaque monkeys after spinal cord transection at T10, both during spinal shock and after reflexes had returned. The rMRglu was measured in all Rexed layers in cord segments both caudal and rostral to the level of the transection utilizing the quantitative [14C]deoxyglucose technique. The monkeys in spinal shock exhibited a significant increase in rMRglu in Rexed layer I and a significant reduction in layers VI to IX of the lumbosacral cord. In contrast, after reflexes had returned the rMRglu was increased in all Rexed layers of the lumbosacral cord; this increase was significant in layers I, V, and VI.