Spinal Cord Lesions
|
Clinical Trials of the Application
of Pulsating Electromagnetic
Energy (Diapulse) in the Treatment of Spinal Cord Lesions
Jerzy Kiwerski and Teresa Chrostowska
Rehabilitation Clinic, Medical Academy,
Warsaw / Konstancini/; Director, Professor M Weiss, MD
Chir. Narz. Ortop, Pot 1980.
VoL 45, no. 3, pp. 273-277. |
Ninety-seven patients underwent treatment. The results of
the treatment are discussed.
Paralysis of muscle groups after injuries to the spinal cord
may result from mechanical destruction of gray matter or spinal
cord tracts. More frequently, however, the decisive factors
are disruptions of blood perfusion, vascular spasms, with the
ischemic changes aggravating the post-traumatic hematoma or
the dynamically increasing spinal edema that extends to the
adjacent areas as well as the injured segment.
Medical treatment cannot counteract irreversible changes caused
by the mechanical damage; our efforts are directed at preventing
the origination and spread of secondary alterations, primarily
vascular effect, and reducing to a minimum the duration of spinal
edema, because the growth, or longer duration of the edema,
leads to irreversible changes in the structure of the spinal
cord In this context it seemed justified to undertake clinical
trials, in the early post-traumatic period, of the Diapulse
technique, which affects three important processes in the post-traumatic
states: 1) reduction of edema and pain, 2) promotion of hematoma
absorption, and 3) increase of the blood perfusion.
The electromagnetic field, acting on the tissues damaged by
the injury, assists the processes of repolarization of the damaged
cells, leads to the proper distribution of electric potentials
on the cell membranes, and thus to their proper conductivity.
Our experiments on an animal model, as well as clinical experience,
seem to support thus far these theoretical assumptions. There
is an undoubted effect of a high-frequency electromagnetic field
that reduces edema (1, 9, 15), improves peripheral circulation
(3, 5, 6, 10), hematoma absorption (2, 4, 15), and even enhances
regeneration processes in the nervous system (1, 13, 14). |
| TECHNICAL DATA AND APPLICATION
TECHNIQUE OF ELECTROMAGNETIC FIELD (EMF). |
In our clinical studies, we used the D 104-A model of the
Diapulse Corporation of America The device generates an electromagnetic
field of high frequency energy (27.12 megahertz ± 0.005
MHz). Energy waves of a duration of65 microseconds are formed
with a controlled frequency of 80 to 600 per second, creating
a mean power of 1.52 to 38 watts (peak power, 25 1-975 W).
Two or three times daily, we applied in the vicinity of the
injury the frequency of 600 Hz, at maximum penetration depth
6, for 20 minutes per session. Once daily, the Diapulse was
applied in the area of the liver and the left adrenal, with
the frequency 400 Hz and penetration depth 4. Session duration
was 15 minutes. The course of treatment was continued for 10
to 30 days post-trauma, with the average of 16 days. |
| CLINICAL MATERIAL |
During the course of 2 years (until September of 1978), we
studied 97 patients with post-traumatic lesions of the spinal
cord. The group included patients admitted to the Warsaw Rehabilitation
Clinic within 24 hours post-injury, mainly with a total or substantial
injury of the spinal cord. Table I gives the patients’
age and the degree of lesion of the vertebral column. As seen
from the table, most patients were individuals of a productive
age (over 78%), which can be linked to the highest frequency
of spinal cord injuries in this age interval. The most frequent
localization of lesions was the lower cervical segment (over
45% of the group studied) or the lower thoracic segment (24%).
Table 1
Level of vertebral column injury
| Patient Age |
C-1 – C4 |
C-5 – C7 |
D-1 – D-5 |
D-6 – D-12 |
L-1 – L-3 |
Total |
| Under 20 |
1 |
1 |
2 |
4 |
1 |
9 |
| 21-40 |
3 |
18 |
3 |
11 |
6 |
41 |
| 41-60 |
3 |
18 |
1 |
7 |
6 |
35 |
| Over 60 |
3 |
7 |
1 |
1 |
- |
12 |
| Total |
10 |
44 |
7 |
23 |
13 |
97 |
Table II gives the degree of lesion of the spinal cord correlated
with the level of the lesion along the vertebral column. The
evaluation of partial spinal cord lesion was made using a three-grade
classification (7): 1) complete paralysis from the level of
the lesion with traces of deep sensibility retained in the feet,
2) deep paresis with retention of traces of functionally ineffective
motor activity, and 3) paresis impairing the function of the
extremities.
TABLE II
Level of vertebral column injury
| Degree of Lesion |
|
C-1 to C-4 |
C-5 to C-7 |
D-1 to D-5 |
D-6 to D12 |
L-1 to L-3 |
Total |
| Complete |
|
1 |
26 |
6 |
18 |
6 |
57 |
| Partial |
1 |
3 |
13 |
1 |
4 |
4 |
25 |
| Partial |
2 |
5 |
5 |
- |
1 |
2 |
13 |
| Partial |
3 |
1 |
- |
- |
- |
1 |
2 |
The majority of patients had complete paralysis (about 60%),
or motor incapacity with retention of traces of deep sensibility
(with the subgroup i of partial paresis accounting for 25%).
These are situations that, with routine treatments, rarely lead
to a marked neurological recovery.
The results of treatment are presented in Table Ill, which indicates
the change of the neurological status as referred to the level
of injury on the vertebral column.
TABLE III
Level Of Vertebral Column Injury
| |
Change in Status |
C1 – C4 |
C5 – C7 |
D1 – D2 |
D6 - D12 |
L1 – L3 |
Total |
| Improvement |
C-1 |
- |
1 |
- |
- |
- |
1 |
| Improvement |
C-2 |
- |
1 |
- |
1 |
- |
2 |
| Improvement |
1-2 |
1 |
2 |
- |
2 |
2 |
7 |
| Improvement |
1-3 |
2 |
11 |
1 |
2 |
1 |
18 |
| Improvement |
2-3 |
3 |
3 |
- |
1 |
2 |
9 |
| Improvement |
3-n |
1 |
- |
- |
- |
- |
1 |
| No Improvement |
C-C |
- |
18 |
6 |
16 |
6 |
46 |
| No Improvement |
2-2 |
1 |
1 |
- |
- |
- |
2 |
| No Improvement |
3-3 |
- |
- |
- |
- |
1 |
1 |
| Death |
|
2 |
7 |
- |
1 |
- |
10 |
A pronounced neurological recovery was observed in 38 patients,
i.e., some 40% of the group under study. Remarkably, in 28 individuals
the recovery had substantial functional value: the patients
were discharged from the Neuro-orthopedic Department with paresis
slightly impairing the function of the extremities. It is noteworthy
that all patients who presented paralysis of extremities with
traces of deep sensibility at the time of admission experienced
a marked neurological recovery. Ten patients died due to complications
(mostly of the respiratory system) in the early post-traumatic
period. Eight of these had complete spinal cord injury in the
cervical segment |
| DISCUSSION |
The results of treatment of the group of
patients with a serious injury to the spinal cord included in
the study can be described as positive. In patients with such
neurological lesions observed at the time of admission, one
rarely attains a definitive neurological improvement. In this
group, it was obtained in 40% of cases.
Is it possible on this basis to conclude with certainty that
EMF had a positive effect on the damaged spinal cord? We do
not think so, because: 1) The group under study is not sufficiently
homogeneous to warrant conclusions of such importance based
on our experience; 2) in clinical conditions we cannot limit
our treatment to EMF as the only method in managing patients
with spinal cord injures.
Our patients were treated simultaneously with anti-edema medications
(such as mannitol and dexametazon), re-position of dislocated
vertebrae by weight traction or surgical intervention (in some
cases, with early relief to the spinal cord via removal of the
fragments of vertebra or disk pressed into the spinal cord canal),
early surgical stabilization of the vertebral column (cervical,
with anterior approach (8), and thoracic and lumbar, by spring
apoplasty (11). In addition, we instituted an early horizontal
positioning and a complete program of therapeutic management
(12).
It is therefore difficult to evaluate in clinical conditions,
given the natural variety of the mechanisms of lesion and clinical
pictures, which of the methods used was primarily responsible
for the achieved neurological recoveries. We attempted to clarify
the doubts in experimental conditions, by selecting identical
or closely similar types of spinal cord lesions induced by means
of precisely dosed injury. The post-injury management of the
animals was confined to the Diapulse technique as the only therapeutic
modality used. It seems that, as a tentative conclusion, the
use of EMF to treat spinal cord lesions improved the neurological
recovery compared to results obtained earlier with other methods.
We are certain that any further conclusions in this area will
require increasing the number of cases of acute injury of the
spinal cord observed and comparing the results with appropriate
control groups. |
| CONCLUSIONS |
1. In patients with complete or deep lesion
to the spinal cord subjected to a Diapulse treatment, a marked
improvement was observed in 38 individuals, i.e., some 40% of
the group studied.
2. Despite the favorable treatment results, it is impossible
to decide unambiguously as to the degree to which the application
of EMF was responsible for the improvements, because of the
diverse neurological pictures of the patients and the simultaneous
administration of other treatments.
3. Experimental studies on animals have been initiated to elucidate
the effects of the Diapulse on the spinal cord lesion with selection
of identical types of lesion and the use of Diapulse as the
only treatment modality. |
| REFERENCES |
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J.: The Diary of the 19th Congress of the Polish Orthopedic
and Traumatological Society, PZWL, Warsaw, 1973, pp. 779-782.
12. Weiss M.: Principles of Management of Traumatic Lesions
of the Spinal Cord, PZWL, Warsaw, 1974.
13. Wilson D.H.: British Med. J., 1972, vol. 2, pp. 269-270.
14. Wilson D.H., Jagadeesh P.: Annals N.Y. Acad. of Sciences,
1974, vol. 238, pp. 575-580.
15. Wright, G.G.: Physiotherapy, 1973, vol. 59, pp. 385-387.
Submitted: December 18, 1978 Authors address: Ul. Stanslawa
14 m. 1, 01-162, Warsaw. |
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