M.Tech. (Chiropractic) / The study evaluated any changes in serum p-endorphin levels before and after a chiropractic adjustment and mobilisation ofthe cervical spine. Three groups of male and female subjects were randomly assigned; the chiropractic group, mobilisation group and detuned ultrasound (control group). Each group consisted of 10 subjects, aged between 18 to 35 with equal numbers of males and females. All subjects were mentally and physically healthy, and were instructed to refrain from nicotine and caffeine intake at least one hour prior to the experiment, as these substances are stimulants and may influence the results. The research protocol involved having blood taken five minutes before the treatment, and repeated five minutes after the treatment. The experimental group received bilateral cervical spine adjustments. The mobilisation group under-went cervical spine mobilisation with oscillatory motion, but no thrust was included. The control group had detuned ultrasound applied to their posterior cervical and trapezius muscles. Blood samples were taken by venipuncture and the p-endorphin levels were analysed using immunoenzymometric assay technique. The results of this study demonstrated that a decrease in p-endorphin levels occurred post intervention in the spinal adjustment group. The mobilisation and detuned ultrasound groups both experienced an increase in p-endorphin levels, but the increase was not statistically significant. This finding allows us to hypothesize that the pain-relieving effects of the chiropractic adjustment, may not be due to a release of p-endorphins, but may be due to the analgesic effect of another system that is not opiate mediated.

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic at Technikon Natal, 1998. / The cause of postnatal low back pain is not clearly understood. There have been few studies performed to determine the cause, and several theories have attempted to explain the occurrence of postnatal low back pain. It is suggested that an exaggerated lumbar lordosis, laxity of the ligaments due to relaxin, biomechanical strain on the muscles and ligaments of the lumbar spine and pelvis and temporary compensatory posture are possible aetiologies of postnatal low back pain. (Calguneri et al. 1982; Bullock et al. 1987 ; Berg et al. 1988; Wisneski et al.1992: 711 ; Mantle 1994:799.) / M

Spinal cord injuries can cause the catastrophic loss of motor and sensory function. The neurological deficits that result are the consequence of not only the primary injury to the spinal cord, but also a complex milieu of secondary pathological processes that are now beginning to be understood. The major mechanisms that underlie this secondary pathology include vascular disruption, ischemia, oxidative stress, excitotoxicity, and inflammation. In light of this, the fact that this secondary pathology occurs after the initial impact makes it potentially amenable to therapeutic intervention. Pharmacotherapies may attenuate some of these processes and minimize secondary damage. Some of the promising treatments that are emerging for acute spinal cord injury are drugs that are already used by physicians for the treatment of unrelated diseases. These drugs, which have already been established to be safe for humans, offer the unique advantage over other novel therapeutic interventions that have yet to be tested in humans. This would save a tremendous amount of time and money needed for human safety studies, if considered as a treatment for spinal cord injury. Examples of such drugs include minocycline (an antibiotic), erythropoietin (a recombinant hormone used to treat anemia), and statins (a popular class of blood cholesterol reducers), all of which have demonstrated the ability to attenuate the various pathophysiological processes initiated after trauma to the central nervous system. In a series of studies, erythropoietin, darbepoetin, atorvastatin, simvastatin, and minocycline were all evaluated for their ability to improve neurologic recovery in a clinically relevant model of spinal cord injury. My experiments revealed that erythropoietin, darbepoetin, atorvastatin and minocycline did not significantly improve neurological recovery. These negative results were in stark contrast to the positive findings which had been published in the literature suggesting that differences in experimental models and methodology influence the neuroprotective efficacy of these drugs. Simvastatin, on the other hand, demonstrated significant improvements in locomotor and histological outcomes. Although this is indeed exciting, the results were modest at best. My results highlight the need for further preclinical work on the above treatments to refine and optimize them prior to proposing them for human testing. / Science, Faculty of / Zoology, Department of / Graduate

This exploratory study was designed to gather information about the needs and concerns of significant others of patients with recent spinal cord injuries. The respondents were asked about the impact of the patients' injuries on their own lives and about their feelings in relation to the treatment they and their patients were receiving from health care personnel. The study was conducted with a convenience sample of seven respondents, five women and two men, designated as significant others by seven patients with recent spinal cord injuries. Using a semi-structured interview guide each significant other was interviewed in depth from one to three times over a period of three to six weeks following their patient's injury. The interview guide covered eight selected themes relating to the significant other's': - need to feel that he or she is getting adequate information - need to feel that he or she is being helpful to the patient - need to feel able to cope with home and family responsibilities - need to have someone from whom he or she can obtain emotional support - need to express feelings, both positive and negative - need to feel that his or her patient is getting good care - past experiences and methods of coping with crisis situations - needs and concerns that may arise because of the likely major effects the patient's injury will have on the significant other's life in the future. All respondents reported needing initial access to physicians who would give a true report of their patients' medical conditions and progresses. Thereafter five respondents reported receiving adequate information from their patients or the nurses. The six respondents who were given a negative prognosis for their patients' recovery of function expressed less apparent emotional conflict than the one who was told there was some possibility of recovery. After the first interview three respondents stressed the need for practical information about how to help with their patients' physical care, although during the first interview all respondents expressed fear that any physical assistance they attempted might harm their patients. All respondents felt their greatest value to their patients was as a source of emotional support. Two respondents reported being able to defer all home and family responsibilities; the other five stated their home and family responsibilities were not directly increased by their patients' injuries. However these five reported stress caused by the necessity of coping with the patients' needs as well as home and family responsibilities. All seven significant others reported using some sources of external support, the most common being family members and close friends. All respondents voiced positive feelings about their patients and the health care they were receiving. Only three respondents expressed strong negative feelings which were directed at the cause of their patients' injuries or what they perceived as incorrect or inappropriate information given to them by health care personnel. All respondents stressed their need to know their patients were receiving good care. All significant others reported their patients' injuries were the severest crises they or their patients had ever undergone, but all also stated they believed they would be able to cope with the crisis. The respondents reported their patients' gravest concerns for the future related to finances, work and sexual functioning. The respondents themselves voiced less concern about finances and sexual functioning. Other concerns for the future expressed by the respondents related to housing, transportation, family activities, social relationships and coping with the inevitable "ups and downs" of the patients. There were some differences in concerns expressed by male and female respondents. The findings of the study demonstrated the presence of selected needs and concerns in a small convenience sample of significant others of spinal cord injured patients. Further research would be necessary to determine whether the findings are representative and whether there is a relationship between expressed needs and concerns and the sex of patients and/or significant others. The study offers suggestions to practicing nurses who wish to improve their care of spinal cord injured patients and their significant others. / Applied Science, Faculty of / Nursing, School of / Graduate

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfillment of the requirements for the degree of Master of Medicine in the branch of Orthopaedic Surgery Johannesburg, 2017 / Background Unstable Thoracolumbar spinal fractures are conventionally treated by open reduction and internal fixation. This involves extensive mobilization of paraspinal muscles, which in turn leads to long-term disability in the form of chronic backache. One of the reasons fractures are stabilized is to prevent kyphotic deformity. Posterior lumbar stabilization done through a minimally invasive technique can achieve the same result as the open technique at the expense of less mobilization of the paraspinal muscles. Aim of the study The aim of the study was to assess the effectiveness of minimally invasive posterior spinal fixation in unstable Thoraco-lumbar fractures in our setting at Charlotte Maxeke Academic Hospital. Objectives To assess the effectiveness of Minimally Invasive Spine Surgery over a short term of minimum of 12 months regarding: Maintaining the correction of fracture kyphosis, Re-operations and Any serious Adverse Events Methodology This was a prospective interventional pilot study. Fractures were classified according to the AO comprehensive system. AO Comprehensive classification fractures A3, B1, B2, C1 and C2 were considered suitable for this technique. Pre-operative, immediate post-operative and one year follow up Cobb’s angles of fracture kyphosis were measured on plain lateral x-rays. Any Serious Adverse Events (SAE) that may have required re-operations were recorded over the minimum of 12 months follow up. Results Twenty patients met the inclusion criteria for this study. Post-operative follow up ranged between 12 and 22 months. There were 14 males and 6 females. The age ranged between 16 years to 54 years with mean of 33.9 years. L1 was the most commonly fractured vertebra. Eleven out of 20 patients sustained fracture of L1, 6 patients had fracture of L2 whereas 3 patients sustained fracture of T12. The AO classification types included one B1, five B2, seven C1 and seven C2 fractures. The pre-operative Cobb’s angle ranged from 7 degrees to 38 degrees with mean of 21.2 degrees. The immediate post-operative Cobb’s angle ranged between zero degrees to 16 degrees with mean of 8.3 degrees. The last follow up Cobb’s angle ranged between zero degrees to 21 degrees with a mean of 10.7 degrees. The loss of correction of fracture kyphosis ranged between zero degrees to 6 degrees with a mean of 2.4 degrees. The post-operative Cobb’s angle was maintained. There was no deterioration of pre-operative neurological status. There was no serious adverse event requiring a re-operation. Conclusion Minimally Invasive Posterior Spinal stabilization for thoracolumbar fractures had an acceptable outcome in our hands in appropriately selected cases. The average loss of correction of 2.4 degrees was in keeping with that found in open technique as well as MIS at other centers. While the number is less, this procedure can be recommended for well selected patients where skills are available. / MT2017

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The vertebrate nervous system arises during embryogenesis from an epithelial sheet of cells called the neural plate that subsequently folds to become a rod of cells called the neural tube. Several signaling pathways act on the neural progenitors of the neural tube to give rise to the diverse set of neurons and glia that will make up the spinal cord and brain in adulthood. In vertebrates, Muscle segment homeobox (Msx) genes are expressed in the dorsal neural tube during development, and pattern dorsal neural progenitors to give rise to dorsal neuronal subtypes. Additionally, Msx genes are involved in the regulation of neurogenesis and proliferation in the neural tube. In zebrafish, three msx genes are expressed in the neural tube: msx1a, msx1b, and msx3. The Akimenko lab has identified a potential enhancer of msx3 called Fragment C that drives expression in the dorsal neural tube. We hypothesized that Fragment C is a bona fide enhancer of msx3 specifically in the neural tube, and that this enhancer contributes toward proper patterning and neurogenesis/proliferation in the developing neural tube of zebrafish. To test this hypothesis, I have generated zebrafish mutants with a deletion of the Fragment C enhancer using CRISPR/Cas9 that also have a transgenic Fragment C enhancer driving reporter expression of enhanced green fluorescent protein (Egfp). The deletion of Fragment C abolishes msx3 expression in the neural tube excluding the dorsal-most cells likely corresponding to the roof plate. The spatial domain in which msx3 is lost corresponds to where Fragment C drives expression in the neural tube, suggesting that Fragment C contains an enhancer of msx3. This domain of expression corresponds to where dorsal neural progenitors reside. Analysis of markers for the cells with Fragment C-driven Egfp expression shows that at least some of these cells are indeed neural progenitors, many of which give rise to neurons during embryonic and larval development. The deletion of Fragment C and loss of msx3 expression in neural progenitors did not affect the numbers of neurons or neural progenitors amongst cells with Fragment C-driven expression, nor did it affect the dorsoventral location of cells in the neural tube. Taken together, we conclude that Fragment C-driven msx3 expression does not contribute to the dorso-ventral position of neural progenitors nor the balance of proliferation and neurogenesis in the developing neural tube. However, a role for msx3 in regulating neural progenitor identity along the dorso-ventral axis without affecting progenitor position cannot be ruled out.

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