Akut spinal kord yaralanması sonrası erken cerrahi dekompresyonun korpus kavernozum ve motor fonksiyon üzerine olan etkilerinin araştırılması

Zekeriya Öztemür, Gündüz Tezeren, Nedim Durmuş, İhsan Bağcıvan, Bülent Saraç, Hayati Öztürk, Okay Bulut
1.003 166

Abstract


Özet

Amaç. Akut spinal kord yaralanması sonrasi erken cerrahi dekompresyonun korpus kavernozum ve motor fonksiyon üzerine olan etkilerinin araştırılması. Yöntem. Yirmi bir adet 9-12 aylık Yeni Zelanda tipi, erişkin erkek tavşan kullanıldı. Denekler kontrol grubu (n=5), laminektomi grubu (n=6), 15 saniye kompresyon grubu (n=5) ve 60 sn kompresyon grubu (n=5) olmak üzere 4 gruba ayrıldı. Laminektomi grubuna sadece laminektomi işlemi yapıldı. Kompresyon gruplarına 60 g kapama gücü olan anevrizma klipsi ile 15 ve 60 saniye kompresyon uygulandı. 1, 3, 5 ve 7. günler Modifiye Tarlov skoru ile motor değerlendirme yapıldı. 7 gün sonunda bütün denekler sakrifiye edilerek spinal kordlarından histopatolojik çalışma ile beraber izole korpus kavernozum dokularından in vitro organ banyosunda kasılma ve gevşeme yanıtları incelendi. Bulgular. Modifiye Tarlov skoruna bakıldığında gruplar arası fark anlamlı bulundu (p<0,05). Korpus kavernozum karbakol ile gevşeme yanıtlarına bakıldığında 15 ve 60 sn’lik kompresyonlu grupta maksimum gevşeme yanıtları istatistiksel olarak benzer idi ve bu gruplardaki maksimum gevşeme yanıtları gerek kontrol gerekse laminektomili gruba göre anlamlı oranda azalmıştı (p<0,05). Laminektomili ve kontrol grupları karşılaştırıldığında maksimum gevşeme yanıtları arasında anlamlı fark bulunmadı (p>0,05). Her 4 grupta da pD2 değerleri benzerdi (p>0,05). Sonuç. Akut spinal kord yaralanmasında erken cerrahi dekompresyonun etkinliğini araştırdığımız bu model ile spinal kord yaralanmasında seksüel disfonksiyonunun tedavisinde kullanılması düşünülen ilaçların in vitro ortamda ayrıntılı olarak araştırılması mümkün olabilir. Akut spinal kord yaralanmasında erken cerrahi dekompresyon motor iyileşme yönünden faydalı olabilir ve korpus kavernozum fonksiyonları açısından olumlu etkiler yapabilir. Ayrıca, akut spinal kord yaralanması geçiren hastalarda erektil disfonksiyon fosfodiesteraz tip V inhibitörleri ile çözülebilir.

Anahtar sözcükler: Spinal kord yaralanması, erken dekompresyon, korpus kavernozum

 

Abstract

Aim. Evaluation of corpus cavernosum and motor function after early surgical decompressssion on acute spinal cord injury. Method. We initiated the study with 21 New Zealand male rabbit. The animals were assigned to four groups which were sham group (n=6), laminectomy group (n=5), 15 seconds compression group (n=5) and 60 seconds compression group (n=5). Fifteen seconds or 60 seconds compression applied to compression group in 60 gram compression force with aneurysm clips. We evaluated motor system with modified Tarlov score at 1st, 3rd, 5th and 7th days of cord injury. All rabbits are sacrificed after 7 day postoperatively. Histopathological evaluations are made on spinal cord and in vitro relaxation and contraction tests were performed on urinary bladder and corpus cavernosum tissues in tissue baths. Results. There was significant difference between all groups according modified Tarlov score (p<0.05). Maximum relaxation response of the corpus cavernosum with carbachol was similar between 15 seconds compression group and 60 seconds compression group and maximum relaxation response of the corpus cavernosum with carbachol decreased in compression group compared with laminectomy and sham groups (p<0.05). pD2 values were similar in four groups (p>0.05). Conclusion. The model used in this study showing the efficacy of early surgical decompression in acute spinal cord injury may be useful to investigate the effects of agents for sexual dysfunction in vitro. Early surgical decompression may develop the motor and corpus cavernosum functions after acute spinal cord injury. In addition, phosphodiesterases type V inhibitors may be useful for treating erectile dysfunction in spinal cord injured patients.

Keywords: Spinal cord injury, early decompression surgery, corpus cavernosum

Keywords


Spinal cord injury, early decompression surgery, corpus cavernosum

Full Text:

PDF


References


Teng YD, Mocchetti I, Taveira-DaSilva AM, Gillis RA, Wrathall JR. Basic fibroblast growth factor increases long-term survival of spinal motor neurons and improves respiratory function after experimental spinal cord injury. J Neurosci 1999; 19: 7037-47.

Bracken MB, Shepard MJ, Collins WF, Holford TR, Young W, Baskin DS, Eisenberg HM, Flamm E, Leo-Summers L, Maroon J, Marshall LF, Perot PL, Piepmeier J, Sonntag VKH, Wagner FC, Wilberger JE, Winn HR. A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. Results of the Second National Acute Spinal Cord Injury Study. N Engl J Med 1990; 322: 1405-11.

Kurtzke JF. Epidemiology of spinal cord injury. Neurol Neurocir Psiquiatr 1977; 18: 157-91.

Khan T, Havey RM, Sayers ST, Patwardhan A, King WW. Animal models of spinal cord contusion injuries. Laboratory Animal Science 1999; 49: 161-72.

Centers for Disease Control (CDC). Acute traumatic spinal cord injury surveillance--United States, 1987. MMWR Morb Mortal Wkly Rep 1988 May 13; 37: 285-6.

Rothman RH, Simeone FA. Spine in: Martinez A, Gren BA, Bunge RP editors: Experimental spinal cord injury: patophysology and treatment 3rd ed. Philadelphia: WB Saunders Company; 1992; pp: 1247-76.

Raslan AM, Nemecek AN. Controversies in the surgical management of spinal cord injuries. Neurol Res Int 2012; 2012: 417834.

Wilson JR, Singh A, Craven C, Verrier MC, Drew B, Ahn H, Ford M, Fehlings MG. Early versus late surgery for traumatic spinal cord injury: the results of a prospective Canadian cohort study. Spinal Cord 2012; 50: 840-3.

Jones CF, Cripton PA, Kwon BK. Gross morphological changes of the spinal cord immediately after surgical decompression in a large animal model of traumatic spinal cord injury. Spine (Phila Pa 1976) 2012; 37: E890-9.

Fehlings MG, Vaccaro A, Wilson JR, Singh A, W Cadotte D, Harrop JS, Aarabi B, Shaffrey C, Dvorak M, Fisher C, Arnold P, Massicotte EM, Lewis S, Rampersaud R. Early versus delayed decompression for traumatic cervical spinal cord injury: results of the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS). PLoS One 2012; 7: e32037.

Bissonette DJ. Sorting out spinal cord syndromes, J Am Acad Phys Assist 1988; 1: 4Bors E, Comarr AE. Neurological disturbances of sexual function with special reference to 529 patients with spinal cord injury. Urol Surv 1960; 110: 191-222.

Phelps G, Brown M, Chen J, Dunn M, Lloyd E, Stefanick ML, Davidson JM, Perkash I. Sexual experience and plasma testosterone levels in male veterans after spinal cord injury.Arch Phys Med Rehabil 1983; 64: 47-52.

Öztemür Z, Tezeren G, Bağcıvan I, Saraç B, Durmuş N, Eğilmez R. Evaluation of urinary bladder function after acute spinal cord injury: an experimental study. Eklem Hastalık Cerrahisi 2010; 21: 110-5.

Tarlov IM, Klinger H, Vitale S. Spinal cord compression studies. I. Experimental techniques to produce acute and gradual compression. AMA Arc Neourol Psychiat 1953; 70: 813-9.

Ducker TB, Lucas JT, Wallace CA. Recovery from spinal cord injury. Neurosurg 1983; 30: 495-513.

Carlson GD, Minato Y, Okada A, Gorden CD, Warden KE, Barbeau JM, Biro CL, Bahnuik E, Bohlman HH, Lamanna JC. Early time-dependent decompression for spinal cord injury: vascular mechanisms of recovery. J Neurotrauma 1997; 14: 951-62.

Chapman JR, Anderson PA. Thoracolumbar spine fractures with neurologic deficit. Orthop Clin North Am 1994; 25: 595-612.

Jarmundowicz W, Lawicki B, Orkisz S. The effect of prolonged spinal cord compression on the extent of morphological changes in experimental spinal cord injury in rabbits. Neurol Neurochir Pol 1997; 31: 1177-88.

Jarmundowicz W, Tosik D, Chlebiński J, Górkiewicz Z. The effect of early decompression on the extent of changes in spinal cord microcirculation in experimental traumatic injury to the cord in rabbits. Neurol Neurochir Pol 1997; 31: 1167-75.

Canale ST. Campbell’s Operative Orthopaedics.in: Leventhal MR editor: Fractures, dislocation and fracture-dislocations of spine.9th ed. St Lois; Mosby; s 1998; 2749.

Kelley M. Can viagra help disabled men-its safe. Accent on Living 1998; 3: 44-7. Farooque M. Spinal cord compression injury in the mouse: presentation of a model including assessment of motor dysfunction. Acta Neuropathol 2000; 100: 13




Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.