E. Barrack. University of Baltimore.

Functionalrolesofthecalfandvastusmus- replaced by a trend to facilitation discount 25 mg phenergan fast delivery, and this change cles in locomotion order phenergan 25 mg mastercard. American Journal of Physical Medicine discount phenergan 25 mg free shipping, is correlated with the degree of rigidity purchase 25 mg phenergan amex. Inhibitory patientsmaynotresultfromatruechangeinIbinhi- interactions between interneurones in reflex pathways bition order phenergan 25 mg overnight delivery. They could reflect the existence of a facil- from group Ia and group Ib afferents in the cat. Journal itated group I excitation overwhelming Ib inhibi- of Physiology (London), 343, 361–79. Effect of knee joint respect, there is independent evidence for facilita- angle on a heteronymous Ib reflex in the human lower tion of transmission in lumbar propriospinal neu- limb. The Canadian Journal of Neurological Sciences, 16, rones in spastic patients. Spasticity, decerebrate rigidity and the clasp-knife phenomenon: an Ib excitation experimental study in the cat. Muscle spindle¨ In spastic patients, whatever the lesion (stroke, activityinmanduringshorteningandlengtheningcontrac- spinal cord injury or multiple sclerosis), the di- tions. Responses to of the soleus H reflex is often obscured by an early passive movement of receptors in joint, skin and muscle group I excitation, which is correlated with hyper- of the human hand. Reflexinhibitionfollowing electrical stimulation over muscle tendons in man. Pattern of projections of group I afferents from forearm muscles to motoneurones supply- REFERENCES ingbicepsandtricepsmusclesinman. Inhibitory pathways from higher motor centres of transmission in Ib reflex pathways in the human upper and forelimb afferents to C3–C4 propriospinal neurones. Correlationoftheinhibitory tions of group I afferents from elbow muscles to motoneu- post-synaptic potential of motoneurones with the latency rones supplying wrist muscles in man. Experimental Brain and time course of inhibition of monosynaptic reflexes. Short- rocal Ia inhibition between ankle flexors and extensors in latencyeffectsoflow-thresholdmuscularafferentfiberson man. Electrophysiological testing of spastic Dysfunction of Ib (autogenic) spinal inhibition in patients patients: its potential usefulness and limitation. InSpasticity:Mechanismsand bitory pathways in patients with hereditary hyperekplexia. Facilitationofquadricepsmotoneurones inhibition (Ib inhibition) in human spasticity. Short-latency autogenic inhibition in patients with Parkin- Fournier, E. Contribution of reticular nuclei to the pathophysi- untary isolated movements in man. Reflex effects from tionsinthehumanlowerlimbonusingrandomlyalternated Golgi tendon organ (Ib) afferents are unchanged after stimulations. Reflex self-regulation of muscle contraction ofmotoneuronescausedbyimpulsesinGolgitendonorgan andautogeneticinhibition. Acomparison lysis of muscular activity in the hindlimb of the cat during of postactivation depression of synaptic actions evoked by unrestrained locomotion. Acta Physiologica Scandinavica, different afferents and at different locations in the feline 75, 105–22. Presynaptic control interneuronesmediatinggroupInon-reciprocalinhibition of transmission along the pathways mediating disynap- ofmotoneuronesinthecat. Facilitation of interneuronal transmission of reflex DecreaseinIb-inhibitionduringhumanstandingandwalk- paths to motoneurones. The adequacy of stretch receptors in the organstoactivecontractionsofthesoleusmuscleinthecat. Annals of the New York Academy of Sciences, Cutaneous facilitation of transmission in reflex pathways 860, 70–82. Cortical modulation of transmission in spinal reflex Physiology (London), 284, 327–43. Integration in extensor motoneurones during fictive locomotion in the descending motor pathways controlling the forelimb in cat. Experimental Brain jection of afferent information from tendon organs in the Research, 26, 521–40. Pathway to the cerebral cortex for impulses from muscle: functional properties and central actions.

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Further allocation of variance revealed a complementary set of neurons that encoded response position irrespective of DNMS phase buy generic phenergan 25 mg online. Ensembles of 10–16 neurons were recorded from the rat hippocampus and analyzed via canonical discriminant analysis (Deadwyler et al discount 25mg phenergan with mastercard. The greatest percent of variance (42%) was contributed by a discriminant function (DF1) that di¤erentiated the sample from the nonmatch phase cheap phenergan 25mg otc. The graph at the bottom right shows the maximum separation of discriminant scores for DF1 at the sample response (SR) and nonmatch response (NR) events purchase phenergan 25 mg on line, with scores near zero during intertrial interval (ITI) best phenergan 25mg, delay, and last nosepoke during the de- lay (LNP). There was no significant di¤erence in firing at left (left trial) or right (right trial) lever positions. The three-dimensional histograms at the left depict the firing of 12 neurons, 6 sample (toward the lower right) and 6 nonmatch (toward the upper left). Note that the same neurons were active during sample or nonmatch phases on both trial types. The rastergrams (top right) show the activity of a single nonmatch cell. The trials are represented by rows, with each dot indicating a single action recorded potential. Note that the same neurons were active during the sample phase of one trial, but also during phase of the other. The single trial rasters at the top right show the firing of a single left posi- tion cell during both sample and nonmatch responses at the left, but not the right, position. The discriminant scores therefore also selectively reflected ensemble encod- ing of response position in the DNMS task. Note that the variance sources contributing to this ensemble activity clearly encoded information consistent with the features or events of the DNMS task. This is not a necessary outcome of the discriminant analysis because there may be sources of variance encoding other sensory, attentional, or motivational features of the task. However, in each case, once a source of variance is identified, it should be possible to identify single neurons that contribute to that variance, and hence demonstrate the same encoding features. The existence of such unexplained components can be a helpful indicator of the task-relevant firing correlates within a particular behavioral paradigm. Deciphering the Code When neurons interact, they inevitably form multiple contacts, making an analysis of functional characteristics of the network at the level of reconstructing individual syn- apses (weights) di‰cult, if not impossible. The problem is that certain input patterns may predominate that are in fact irrelevant to information a prosthetic network is required to process. Therefore, it cannot be assumed that the network will process the information necessary to perform the task unless some preassessment is utilized to limit the manner in which information is to be dichotomized. The identification of neurons that encode di¤erent features of a task which com- prise a neural network is diagrammed in figure 6. Inputs to the network consist of the salient sensory features of the task, such as phase and position, as well as other features not yet determined. The second largest source of variance (15%) discriminated the left from right response position. The discriminant scores at the bottom right indicate a positive score for right and a negative score for left sample responses; however, on the same trial, the scores reversed, since responses during the nonmatch phase were at the opposite position. The 3-D histo- grams at left show the same 12 neurons, 6 left (toward lower right on cell axis) and 6 right (toward upper right on cell axis) encoded reciprocally on left and right trials, irrespective of DNMS phase (see figure 2). Cognitive Processes in Replacement Brain Parts 119 Phase Cells Position Cells?? X0 X1 Xm Xm+1 XM Input Layer: Task Features w1,0 w1,1 wj,0 wj,M wK,0 wK,M w wj,m 1,M rj r1 r K Output Layer: Event Encoding y Conjunctive Cell Figure 6. The network is diagrammed as a three-layer perceptron, with the phase and position encoding cells in the input layer. The more a network receives broad descriptive inputs, the more it is capable of encoding discrete behavioral events. Multiple parallel networks would allow for a whole population of neurons capable of encoding all relevant events within a given task or behavioral context. Individual neurons were identified that encoded single DNMS events that were combinations of task phase and response position (e. Note that these neurons were not identified by one distinct source of variance, since conjunctive neurons are influ- enced equally by identified phase and position components. Thus conjunctive neu- rons most likely represent the operation of a network (figure 6. Neurons encoding discrete events were not iden- tified by a separate source of variance, but contributed to the encoding derived by DF1 and DF2.

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Muscle Nerve 12:647– blood supply of the vertebral column des menschlichen Körpers discount 25 mg phenergan with visa. De Mattei M order phenergan 25 mg line, Paschero B generic phenergan 25mg without prescription, Sciarretta A phenergan 25 mg sale, M discount phenergan 25mg with visa, Chiba K, Suzuki N, Fujimura Y of 1153 motor axon reflexes. Second Davini O, Cocito D (1993) Usefulness (2000) Increased signal intensity of the part: contralateral motor axon reflex of motor evoked potentials in compres- spinal cord on magnetic resonance im- crossed facial reinnervation. Electromyogr Clin ages in cervical compressive myelopa- tromyogr Clin Neurophysiol 18:311– Neurophysiol 33:205–216 thy. Sampath P, Bendebba M, Davis JD, Yamashita K, Ono K (1988) Myelopa- 682 Ducker TB (2000) Outcome of patients thy hand characterized by muscle wast- 23. A different type of myelopathic cal stimulation over the human verte- prospective, multicenter study with in- hand in patients with cervical spondy- bral column: which neuronal elements dependent clinical review. Shea P, Woods W, Werden D (1950) MAC (1988) Delayed short-latency so- 24. Morio Y, Teshima R, Nagashima H, Electromyography in diagnosis of matosensory evoked potentials in pre- Nawata K, Yamasaki D, Nanjo Y nerve root compression syndrome. Elec- outcomes of cervical compression tromyogr Clin Neurophysiol 28:361– myelopathy and MRI of the spinal 368 cord. Wilbourn A, Aminoff M (1988) AAEE (1993) Scapulohumeral reflex (Shimi- chondrotischer Röntgenbefunde der Mini Monograph 32. Its clinical significance and testing Halswirbelsäule bei 400 symptom- ological examination in patients with maneuver. Töndury G, Theiler K (1990) Entwick- 1011–1014 ation of motor evoked potentials lungsgeschichte und Fehlbildungen der 44. Yonenobu K (2000) Cervical radicu- (MEPs) by magnetic stimulation in Wirbelsäule, 2nd edn. Hippokrates- lopathy and myelopathy: when and cervial spondylotic myelopathy. Neu- Verlag, Stuttgart what can surgery contribute to treat- roorthopedics 125:75–89 41. Taylor J, Tworney L (1993) Acute in- and somatosensory evoked potentials juries to cervical joints: an autopsy in cervical spinal stenosis. Spine 18:1115– the 40th Congress of the Czech and 1122 Slovak Neurophysiology, Brno 42. Wälchli B, Dvorak J (1998) Axial symptoms including cervical migraine and cervical angina. In: Ono K, Dvorak J, Dunn E (eds) Cervical spondylosis and similar disorders. Pavlov Anterior decompression for cervical spondylotic myelopathy Abstract Cervical spondylotic procedures, complications, and out- myelopathy is a clinical entity that come are discussed here. The Keywords Cervical spondylotic goal of treatment is to decompress myelopathy · Anterior surgery · P. Pavlov (✉) the spinal cord and stabilize the Fusion · Decompression Institute for Spine Surgery and spine in neutral, anatomical position. Box 9011, sion of the cord are localized in front 6500GM Nijmegen, The Netherlands of the cord, it is obvious that an an- Tel. The different surgical the offending pathology allows atraumatic and extensive Introduction decompression. In cervical spondylotic myelopathy (CSM) there is dysfunc- tion of the spinal cord because of degenerative changes in Surgical strategy the spine. Essentially there are two major The goal of surgical treatment is to achieve a maximum of mechanisms which cause myelopathy: direct compression decompression without compromising the spinal stability of the cord and ischemic changes because of alterations in and respecting the sagittal profile of the spine. Since studies on the affected area the decompression may be executed have demonstrated that the pathology of CSM is located through a simple discectomy, with or without fusion, or predominantly anteriorly, it seems logical to approach through extensive vertebrectomy with grafting and inter- the spine where the lesion is and choose an anterior ap- nal fixation. Removal of extruding intervertebral disc, spurs, a discectomy without fusion [60, 90], but the majority of osteophytes and calcified posterior longitudinal ligament patients included in those studies had disc herniation and relieves the compression of the anterior cord and improves not CSM. The nonfusion discectomy eliminates the radic- to some extent the blood supply to the cord. The surgical ular symptoms in most of the cases but results for a long approach as described by Smith and Robinson covers time in axial neck pain and compromises the lordotic cur- the area between the vertebral bodies of C2 and T1. This is the reason why discectomy is tients with long slender necks the vertebral body of T3 may predominantly combined with interbody fusion today.

Many surgeons believe that the loss of laminectomy for CSM buy generic phenergan 25mg on-line, developmental cervical canal steno- ROM has a favorable effect on the neurological outcome sis purchase phenergan 25mg, and OPLL is probably lower than has been believed 25mg phenergan visa. Few patients Mikawa and his coworkers reported that no deformity de- complain of the inconvenience of decreased ROM of the veloped after multilevel laminectomy for spondylosis discount 25 mg phenergan fast delivery, and neck buy generic phenergan 25mg online, which generally occurs after multisegmental ante- that deformity developed more often in OPLL. Hence, patient complaints of ROM re- series, 21% of laminectomy patients showed deterioration duction after laminoplasty may derive from a combination of neurological symptoms due to cervical spine instability. Approximately half of them had a straight spine before sur- gery and their symptoms worsened in association with the development of kyphosis triggered by minor trauma. Long-term results All of the patients with kyphotic alignment before sur- gery showed worsening of their alignment after laminoplasty, Laminoplasty was developed in the late 1970s, and various while no patient with lordotic alignment before surgery modifications were reported in the early 1980s. The de- only a few follow-up studies over 10 years have been pub- gree of lordosis in the patients with lordotic alignment be- lished [15, 29]. Miyazaki and coworkers carried out a study fore surgery decreased slightly, but no patient developed with a mean follow-up of 12 years and 11 months, and re- kyphotic deformity of the cervical spine. After spinous ported that improvement after surgery was maintained process splitting laminoplasty in our series, 26. Kawai and his associates followed up patients who patients showed deterioration of spinal alignment. Hira- had undergone a Z-laminoplasty for 10 years on average, bayashi and his associates did not note any postoperative and reported that spondylotic myelopathy was stable, in 118 contrast to the results for OPLL. The reasons for this symptoms are usually improved, and no regression of the difference were not described in detail. These factors might influence incidence in relation to the surgical procedure in their own se- the long-term results of surgical treatment to varying de- ries. Complications This complication has been rarely reported to occur af- ter laminectomy, and the mechanism of this complication Generally, the complications of laminoplasty are similar to has not yet been fully clarified. However, nonneurological compli- to posterior migration of the spinal cord has been sug- cations are relatively rare compared with other procedures gested to be the major cause [26, 27, 33]. Delayed healing or dehiscence of This entity may be differentiated from nerve root or the surgical wound may occur slightly more frequently af- spinal cord palsy due to mechanical compression by CT ter laminoplasty than with laminectomy, and this may be scanning with or without contrast medium. The incidence controlled with nonsteroid anti-inflammatory drugs and/or of neurological complications attributed to this operation is analgesics. Neck traction in the neutral position may also less in laminoplasty because of simultaneous decompres- reduce pain. The motor paralysis usually recovers to nor- sion and the use of air-driven instruments. Severe spondylotic ever, complications characteristic to this procedure, which changes, especially at the root tunnel, and spinal cord at- are nerve root palsy and axial (neck and shoulder) pain. Although the alignment of the cervical spine, creased since the reconstructed or preserved laminae still the relative position of the facets to the vertebral body, have a protective function to diminish blood pooling and and the distance from the cord to the dura–nerve root soft tissue swelling after surgery. We have experienced junction were all analyzed, no factor was proven to be a this complication in only 0. Foraminotomy or facetectomy has not been proven to Fracture of a hinge or loss of spinal canal enlargement be a preventive measure. However, controlled opening of due to insufficient fixation of the lifted lamina is reported the lamina can prevent this problem – although a defini- to cause nerve root or spinal cord palsy when a lamina mi- tive method for control of opening has not been found. Computerized tomography Postoperatively, patients with laminoplasty complain (CT) is useful for delineating the pathology in this case, of various axial symptoms such as nuchal pain and stiff- and total or partial removal of the lifted lamina is neces- ness of the neck and shoulder muscles. The prognosis is usually good if salvage is carried ally appeared on the hinge side in our en-bloc lamino- out promptly. After Nerve root palsy due to thermal damage or mechanical spinous process splitting laminoplasty, a few of the patients injury to the nerve root is known to develop occasionally complained of neck and/or shoulder pain. The symptoms following posterior decompression, and a different type of were usually distributed on both sides. The causes of these nerve root palsy is reported to occur after laminoplasty symptoms are not clear. The initial symptom is severe pain in the the facet joints caused by surgical intervention may be the shoulder and upper arm, which is followed by paresis or cause. The symptoms resolved by about 1 year after sur- paralysis of the deltoid and biceps brachii muscles. However, axial symptoms are the is a motor-dominant type of nerve root paralysis. The for- chief complaint in some patients, and their cause should mer symptom is the more frequent form of this complica- also be clarified.

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