Heat-provoked skin vasodilatation in innervated and denervated trunk dermatomes in human spinal cord injury.

Publisher: Stockton Press Country of Publication: England NLM ID: 9609749 Publication Model: Print Cited Medium: Print ISSN: 1362-4393 (Print) Linking ISSN: 13624393 NLM ISO Abbreviation: Spinal Cord Subsets: MEDLINE

Original Publication: Houndmills, Basingstoke, Hampshire, UK : Stockton Press, c1996-

Body Temperature Regulation*/physiology ; Reflex, Abnormal*/physiology; Autonomic Nervous System Diseases/*diagnosis ; Autonomic Nervous System Diseases/*physiopathology ; Spinal Cord Injuries/*physiopathology ; Sympathetic Fibers, Postganglionic/*physiopathology; Adult ; Autonomic Nervous System Diseases/etiology ; Blood Vessels/innervation ; Blood Vessels/physiopathology ; Case-Control Studies ; Cross-Sectional Studies ; Denervation/adverse effects ; Female ; Hot Temperature/adverse effects ; Humans ; Laser-Doppler Flowmetry ; Male ; Middle Aged ; Peripheral Nerves/physiopathology ; Regional Blood Flow/physiology ; Skin/blood supply ; Skin/innervation ; Skin/physiopathology ; Spinal Cord Injuries/complications ; Spinal Cord Injuries/diagnosis ; Vasodilation/physiology ; Vasomotor System/physiopathology

Study Design: Cross-sectional, observational, controlled study.
Objective: High spinal cord injury (SCI) results in disruption of sympathetic vasomotor control. Vasodilatation as a response to local heating is a biphasic mechanism: the first phase (neurogenic) is mediated by the axon-reflex and is modulated by activity of sympathetic nerves. Our objective was to determine whether the response to heat provocation in trunk dermatomes may provide a measure of vasomotor sympathetic function in SCI.
Setting: National Spinal Injuries Centre, Stoke Mandeville Hospital, Buckinghamshire, UK; Autonomic Unit, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Neurovascular Medicine Unit, Imperial College London at St Mary's Hospital, UK.
Subjects: A total of 30 subjects were studied; 18 had chronic complete SCI (level C6-T11) and 12 were healthy controls.
Methods: Recordings of skin blood flow (SkBF) were obtained with thermostatic laser Doppler probes placed in the upper trunk (at C4) and lower trunk (T10 or T12) dermatomes.
Results: SkBF at baseline (SkBF(bas)) and SkBF at the first peak of vasodilatation (SkBF(max)) showed no significant differences between SCI and controls either in upper or lower trunk dermatomes. However, the ratio of SkBF(max)/SkBF(bas) was significantly different in lower trunk dermatomes in SCI at C6-T5 level (7.5+/-3.5 PU) compared to SCI at T6-T11 level (3.5+/-1.5 PU) (P < 0.01).
Conclusion: Measurement of SkBF in response to local heating may provide a safe, noninvasive method to assess integrity of sympathetic spinal pathways to the local vasculature. This may aid the classification of the SCI lesions, as the autonomic component currently is not included in the accepted American Spinal Injury Association scoring.

Date Created: 20050921 Date Completed: 20060608 Latest Revision: 20110606

20231215

10.1038/sj.sc.3101837

16172627