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Zheng Z, Chen J, Xu J, Jiang B, Li L, Li Y, Dai Y, Wang B. Peripheral blood RNA biomarkers can predict lesion severity in degenerative cervical myelopathy. Neural Regen Res 2025; 20:1764-1775. [PMID: 39104114 PMCID: PMC11688566 DOI: 10.4103/nrr.nrr-d-23-01069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/10/2023] [Accepted: 11/23/2023] [Indexed: 08/07/2024] Open
Abstract
JOURNAL/nrgr/04.03/01300535-202506000-00027/figure1/v/2024-08-05T133530Z/r/image-tiff Degenerative cervical myelopathy is a common cause of spinal cord injury, with longer symptom duration and higher myelopathy severity indicating a worse prognosis. While numerous studies have investigated serological biomarkers for acute spinal cord injury, few studies have explored such biomarkers for diagnosing degenerative cervical myelopathy. This study involved 30 patients with degenerative cervical myelopathy (51.3 ± 7.3 years old, 12 women and 18 men), seven healthy controls (25.7 ± 1.7 years old, one woman and six men), and nine patients with cervical spondylotic radiculopathy (51.9 ± 8.6 years old, three women and six men). Analysis of blood samples from the three groups showed clear differences in transcriptomic characteristics. Enrichment analysis identified 128 differentially expressed genes that were enriched in patients with neurological disabilities. Using least absolute shrinkage and selection operator analysis, we constructed a five-gene model (TBCD, TPM2, PNKD, EIF4G2, and AP5Z1) to diagnose degenerative cervical myelopathy with an accuracy of 93.5%. One-gene models (TCAP and SDHA) identified mild and severe degenerative cervical myelopathy with accuracies of 83.3% and 76.7%, respectively. Signatures of two immune cell types (memory B cells and memory-activated CD4+ T cells) predicted levels of lesions in degenerative cervical myelopathy with 80% accuracy. Our results suggest that peripheral blood RNA biomarkers could be used to predict lesion severity in degenerative cervical myelopathy.
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Affiliation(s)
- Zhenzhong Zheng
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Jialin Chen
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Jinghong Xu
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Bin Jiang
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Lei Li
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Yawei Li
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Yuliang Dai
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Bing Wang
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
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Kann MR, Lavadi RS, Crane A, Aizooky T, Hardi A, Polavarapu H, Kumar RP, Mitha R, Shah M, Hamilton DK, Agarwal N. Fluid biomarkers for cervical spondylotic myelopathy. Neurosurg Rev 2025; 48:232. [PMID: 39945892 DOI: 10.1007/s10143-025-03217-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Revised: 12/02/2024] [Accepted: 01/07/2025] [Indexed: 05/09/2025]
Abstract
INTRODUCTION There is a scarcity of literature exploring fluid-based biomarkers that have the potential to provide deeper insights into the cellular mechanisms underlying cervical spondylotic myelopathy (CSM) symptom presentation and postoperative recovery. This systematic review synthesized the literature on invasive, fluid-based biomarkers and their clinical significance with CSM. MATERIALS AND METHODS A comprehensive search strategy was developed for concepts of biomarkers and CSM. Retrieved results underwent title, abstract, and full-text screening with inclusion criteria being original research including animal or human subjects affected by CSM/compression myelopathy that investigated the relationship between a fluid-based biomarker and CSM. Risk-of-bias was reported using the OHAT Risk of Bias Rating Tool. RESULTS The search strategy resulted in 191 unique manuscripts, with 20 meeting the predetermined inclusion/exclusion criteria, included in final analysis. Of these, 15 (75.0%) were human studies, two (10.0%) were animal studies, and three studies (15.0%) included both human and animal subjects. Across human studies, the fluid utilized for biomarker assessment was blood, (N = 8, 44.4%), cerebrospinal fluid (CSF) (N = 9, 50.0%), and both blood and CSF (N = 1, 5.6%). The three most common biomarkers assessed across human studies were NSE (N = 4, 22.2%), S100b (N = 4, 22.2%), and pNF-H (N = 4, 22.2%). Risk of bias due to inadequate comparison groups was present in three human studies (16.7%) and two animal studies (40%). CONCLUSIONS This comprehensive systematic review identified several associations between blood and CSF-based neural, glial, and inflammatory biomarkers and CSM. However, the vast heterogeneity across studies renders it difficult to draw definitive conclusions. Future research within larger, prospective patient cohorts is needed to fully elucidate the utility these biomarkers may hold in the clinical evaluation of patients with CSM.
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Affiliation(s)
- Michael R Kann
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Raj Swaroop Lavadi
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Alex Crane
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Taim Aizooky
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Angela Hardi
- Becker Medical Library, Washington University School of Medicine, St. Louis, MO, USA
| | - Hanish Polavarapu
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Rohit Prem Kumar
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Rida Mitha
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Manan Shah
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - D Kojo Hamilton
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
- Neurological Surgery, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA.
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Doi T, Inoue T, Sugaya J, Horii C, Tozawa K, Nakarai H, Sasaki K, Yoshida Y, Ito Y, Ohtomo N, Sakamoto R, Nakajima K, Nagata K, Okamoto N, Nakamoto H, Kato S, Taniguchi Y, Matsubayashi Y, Tanaka S, Okazaki K, Oshima Y. Noninvasive Skin Autofluorescence of Advanced Glycation End Products in Patients with Degenerative Cervical Myelopathy. World Neurosurg 2025; 194:123556. [PMID: 39653077 DOI: 10.1016/j.wneu.2024.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2024] [Accepted: 12/04/2024] [Indexed: 12/30/2024]
Abstract
OBJECTIVE To clarify the association between skin autofluorescence of advanced glycation end products (AGEs) and clinical outcomes and pain in patients with degenerative cervical myelopathy (DCM). METHODS Consecutive patients with DCM were prospectively enrolled. AGEs assessed by skin autofluorescence (the AGE score) were examined at the middle fingertip in eligible patients. Patients were divided into lower AGE score (AGE-L) and higher AGE score (AGE-H) groups based on a cutoff AGE score of 0.54. Demographic data, laboratory data, maximum spinal cord compression, clinical outcomes, such as European Quality of Life-5 Dimensions, Neck Disability Index, and Japanese Orthopaedic Association score, and Numerical Rating Scale (NRS) score for neck, arm, hand, leg, and foot pain were compared between the two groups. Multiple linear regression analysis was performed to assess the association between the AGE score and the NRS score for pain in the lower limbs. RESULTS Of the 263 patients, 93 were included in this study (41 with the AGE-L group and 52 with the AGE-H group). Demographic data, laboratory data, maximum spinal cord compression, and clinical outcomes were comparable between the two groups. The AGE-H group had significantly higher NRS scores for leg and foot pain than the AGE-L group. Multiple linear regression analysis revealed that higher AGE scores were significantly associated with more severe pain in the lower limbs in patients with DCM. CONCLUSIONS Noninvasive skin autofluorescence of AGEs may be a useful biomarker for pain symptoms in the lower limbs in patients with DCM.
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Affiliation(s)
- Toru Doi
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan; Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo, Japan.
| | - Tomohisa Inoue
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Jun Sugaya
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Chiaki Horii
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Keiichiro Tozawa
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Nakarai
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Katsuyuki Sasaki
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Yuichi Yoshida
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Yusuke Ito
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Nozomu Ohtomo
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Ryuji Sakamoto
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Koji Nakajima
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Kosei Nagata
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Naoki Okamoto
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Hideki Nakamoto
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - So Kato
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Yuki Taniguchi
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | | | - Sakae Tanaka
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
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Nicholson E, Jaconelli T, Crane S. Can levels of neuron-specific enolase be used in the diagnostic workup of possible cauda equina syndrome? Emerg Med J 2024; 41:700-701. [PMID: 39153847 DOI: 10.1136/emermed-2024-214288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2024]
Abstract
A shortcut review of the literature was carried out to examine whether the measurement of neuron-specific enolase (NSE) can be used as a marker to exclude spinal cord, cauda equina or other significant spinal nerve root compression. 132 papers were found of which 4 included data on patients relevant to the clinical question, these are discussed in the paper. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of the best papers are tabulated. The clinical bottom line is that to date there is no evidence to suggest that measurement of NSE would be beneficial in clinical practice to rule out compression.
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Affiliation(s)
- Emily Nicholson
- Department of Emergency Medicine, York Hospital, York, North Yorkshire, UK
| | - Tom Jaconelli
- Department of Emergency Medicine, York Hospital, York, North Yorkshire, UK
| | - Steven Crane
- Department of Emergency Medicine, York Hospital, York, North Yorkshire, UK
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Costa P, Borio A, Marmolino S, Turco C, Serpella D, Della Cerra E, Cipriano E, Ferlisi S. The role of intraoperative extensor digitorum brevis muscle MEPs in spinal surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:3360-3369. [PMID: 37336795 DOI: 10.1007/s00586-023-07811-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/11/2023] [Accepted: 06/03/2023] [Indexed: 06/21/2023]
Abstract
PURPOSE Intraoperative muscle motor evoked potentials (m-MEPs) are widely used in spinal surgery with the aim of identifying a damage to spinal cord at a reversible stage. Generally, lower limb m-MEPs are recorded from abductor hallucis [AH] and the tibialis anterior [TA]. The purpose of this work is to study an unselected population by recording the m-MEPs from TA, AH and extensor digitorum brevis (EDB), with the aim of identifying the most adjustable and stable muscles responses intraoperatively. METHODS Transcranially electrically induced m-MEPs were intraoperative recorded in a total of 107 surgical procedures. m-MEPs were recorded by a needle electrode placed in the muscle from TA, AH and EDB muscles in the lower extremities. RESULTS Overall monitorability (i.e., at least 1 Lower Limb m-MEP recordable) was 100/107 (93.5%). In the remaining 100 surgeries in 3 cases, the only muscle that could be recorded at baseline was one AH, and in other 2 the EDB. Persistence (i.e., the recordability of m-MEP from baseline to the end of surgery) was 88.7% for TA, 89.8% for AH and 93.8% for EDB. CONCLUSION In our series, EDB m-MEPs have demonstrated a recordability superior to TA and a stability similar to AH. The explanations may be different and range from changes in the excitability of the cortical motor neuron to the different sensitivity to ischemia of the spinal motor neuron. EDB can be used alternatively or can be added to TA and AH as a target muscle of the lower limb in spinal surgery.
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Affiliation(s)
- Paolo Costa
- Department of Neurosciences and Mental Health, Section of Clinical Neurophysiology, Città della Salute e della Scienza, Turin, EU, Italy.
| | - Alessandro Borio
- Department of Neurosciences and Mental Health, Section of Clinical Neurophysiology, Città della Salute e della Scienza, Turin, EU, Italy
| | - Sonia Marmolino
- Department of Neurosciences and Mental Health, Section of Clinical Neurophysiology, Città della Salute e della Scienza, Turin, EU, Italy
| | - Cristina Turco
- Department of Neurosciences and Mental Health, Section of Clinical Neurophysiology, Città della Salute e della Scienza, Turin, EU, Italy
| | - Domenico Serpella
- Department of Neurosciences and Mental Health, Section of Clinical Neurophysiology, Città della Salute e della Scienza, Turin, EU, Italy
| | - Elena Della Cerra
- Department of Neurosciences and Mental Health, Section of Clinical Neurophysiology, Città della Salute e della Scienza, Turin, EU, Italy
| | - Elia Cipriano
- Department of Translational Medicine, Section of Neurology, University of Piemonte Orientale, Novara, Italy
| | - Salvatore Ferlisi
- Department of Biomedicine, Neurosciences and Advanced Diagnostic (BiND), University of Palermo, Palermo, Italy
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Tsitsopoulos PP, Mondello S, Holmström U, Marklund N. Cerebrospinal fluid biomarkers of white matter injury and astrogliosis are associated with the severity and surgical outcome of degenerative cervical spondylotic myelopathy. Spine J 2022; 22:1848-1856. [PMID: 35753639 DOI: 10.1016/j.spinee.2022.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 06/09/2022] [Accepted: 06/16/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Degenerative cervical spondylotic myelopathy (DCM) is the commonest form of spinal cord injury in adults. However, a limited number of clinical reports have assessed the role of biomarkers in DCM. PURPOSE We evaluated cerebrospinal fluid (CSF) biomarkers in patients scheduled for DCM surgery and hypothesized that CSF biomarkers levels (1) would reflect the severity of preoperative neurological status; and (2) correlate with radiological appearance; and (3) correlate with clinical outcome. STUDY DESIGN/SETTING Prospective clinical and laboratory study. PATIENT SAMPLE Twenty-three DCM patients, aged 66.4±12.8 years and seven controls aged 45.4±5.3 years were included. OUTCOME MEASURES The American Spinal Injury Association Impairment Scale, the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire and EuroQol 5-dimensions were assessed preoperatively and at 3 months post-surgery. METHODS We measured preoperative biomarkers (glial fibrillary acidic protein [GFAP], neurofilament light [NFL], phosphorylated neurofilament-H [pNF-H] and Ubiquitin C-terminal hydrolase L1) in CSF samples collected from patients with progressive clinical DCM who underwent surgical treatment. Biomarker concentrations in DCM patients were compared with those of cervical radiculopathy controls. RESULTS The median symptom duration was 10 (interquartile range 6) months. The levels of GFAP, NFL, pNF-H, Ubiquitin C-terminal hydrolase L1 were significantly higher in the DCM group compared to controls (p=.044, p=.002, p=.016, and p=.006, respectively). Higher pNF-H levels were found in patients with low signal on T1 Magnetic Resonance Imaging sequence compared to those without (p=.022, area under the receiver operating characteristic curve [AUC] 0.780, 95% Confidence Interval: 0.59-0.98). Clinical improvement following surgery correlated mainly with NFL and GFAP levels (p<.05). CONCLUSIONS Our results suggest that CSF biomarkers of white matter injury and astrogliosis may be a useful tool to assess myelopathy severity and predict outcome after surgery, while providing valuable information on the underlying pathophysiology.
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Affiliation(s)
- Parmenion P Tsitsopoulos
- Department of Neurosurgery, Hippokratio General Hospital, Constantinoupoleos 49, 54642, Aristotle University School of Medicine, Thessaloniki, Greece; Department of Neuroscience, Neurosurgery, Sjukhusvägen 3, 751 85, Uppsala University Hospital, Uppsala, Sweden.
| | - Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, A.O.U. "Policlinico G. Martino" Via Consolare Valeria, 98125, University of Messina, Messina, Italy
| | - Ulrika Holmström
- Department of Neuroscience, Neurosurgery, Sjukhusvägen 3, 751 85, Uppsala University Hospital, Uppsala, Sweden
| | - Niklas Marklund
- Department of Clinical Sciences Lund, Neurosurgery, Lund University, Skåne University Hospital Klinikgatan 17A, 221 85 Lund, Sweden
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Jentzsch T, Cadotte DW, Wilson JR, Jiang F, Badhiwala JH, Akbar MA, Rocos B, Grossman RG, Aarabi B, Harrop JS, Fehlings MG. Spinal Cord Signal Change on Magnetic Resonance Imaging May Predict Worse Clinical In- and Outpatient Outcomes in Patients with Spinal Cord Injury: A Prospective Multicenter Study in 459 Patients. J Clin Med 2021; 10:4778. [PMID: 34682902 PMCID: PMC8537526 DOI: 10.3390/jcm10204778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/22/2021] [Accepted: 10/04/2021] [Indexed: 12/16/2022] Open
Abstract
Prognostic factors for clinical outcome after spinal cord (SC) injury (SCI) are limited but important in patient management and education. There is a lack of evidence regarding magnetic resonance imaging (MRI) and clinical outcomes in SCI patients. Therefore, we aimed to investigate whether baseline MRI features predicted the clinical course of the disease. This study is an ancillary to the prospective North American Clinical Trials Network (NACTN) registry. Patients were enrolled from 2005-2017. MRI within 72 h of injury and a minimum follow-up of one year were available for 459 patients. Patients with American Spinal Injury Association impairment scale (AIS) E were excluded. Patients were grouped into those with (n = 354) versus without (n = 105) SC signal change on MRI T2-weighted images. Logistic regression analysis adjusted for commonly known a priori confounders (age and baseline AIS). Main outcomes and measures: The primary outcome was any adverse event. Secondary outcomes were AIS at the baseline and final follow-up, length of hospital stay (LOS), and mortality. A regression model adjusted for age and baseline AIS. Patients with intrinsic SC signal change were younger (46.0 (interquartile range (IQR) 29.0 vs. 50.0 (IQR 20.5) years, p = 0.039). There were no significant differences in the other baseline variables, gender, body mass index, comorbidities, and injury location. There were more adverse events in patients with SC signal change (230 (65.0%) vs. 47 (44.8%), p < 0.001; odds ratio (OR) = 2.09 (95% confidence interval (CI) 1.31-3.35), p = 0.002). The most common adverse event was cardiopulmonary (186 (40.5%)). Patients were less likely to be in the AIS D category with SC signal change at baseline (OR = 0.45 (95% CI 0.28-0.72), p = 0.001) and in the AIS D or E category at the final follow-up (OR = 0.36 (95% CI 0.16-0.82), p = 0.015). The length of stay was longer in patients with SC signal change (13.0 (IQR 17.0) vs. 11.0 (IQR 14.0), p = 0.049). There was no difference between the groups in mortality (11 (3.2%) vs. 4 (3.9%)). MRI SC signal change may predict adverse events and overall LOS in the SCI population. If present, patients are more likely to have a worse baseline clinical presentation (i.e., AIS) and in- or outpatient clinical outcome after one year. Patients with SC signal change may benefit from earlier, more aggressive treatment strategies and need to be educated about an unfavorable prognosis.
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Affiliation(s)
- Thorsten Jentzsch
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON M5T 2S8, Canada; (T.J.); (J.R.W.); (F.J.); (J.H.B.); (M.A.A.); (B.R.)
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON M5G 2C4, Canada
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - David W. Cadotte
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary Combined Spine Program, Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Jefferson R. Wilson
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON M5T 2S8, Canada; (T.J.); (J.R.W.); (F.J.); (J.H.B.); (M.A.A.); (B.R.)
- Division of Neurosurgery, St. Michael’s Hospital, University Health Network, Toronto, ON M5T 2S8, Canada
| | - Fan Jiang
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON M5T 2S8, Canada; (T.J.); (J.R.W.); (F.J.); (J.H.B.); (M.A.A.); (B.R.)
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Jetan H. Badhiwala
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON M5T 2S8, Canada; (T.J.); (J.R.W.); (F.J.); (J.H.B.); (M.A.A.); (B.R.)
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Muhammad A. Akbar
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON M5T 2S8, Canada; (T.J.); (J.R.W.); (F.J.); (J.H.B.); (M.A.A.); (B.R.)
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Brett Rocos
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON M5T 2S8, Canada; (T.J.); (J.R.W.); (F.J.); (J.H.B.); (M.A.A.); (B.R.)
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Robert G. Grossman
- Department of Neurosurgery, Houston Methodist Hospital, Houston, TX 77030, USA;
| | - Bizhan Aarabi
- Department of Neurosurgery, University of Maryland Medical Center and R Adams Cowley Shock Trauma Center, Baltimore, MD 21201, USA;
| | - James S. Harrop
- Departments of Neurological Surgery and Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USA;
| | - Michael G. Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON M5T 2S8, Canada; (T.J.); (J.R.W.); (F.J.); (J.H.B.); (M.A.A.); (B.R.)
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON M5G 2C4, Canada
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Tsitsopoulos PP, Holmström U, Blennow K, Zetterberg H, Marklund N. Cerebrospinal fluid biomarkers of glial and axonal injury in cervical spondylotic myelopathy. J Neurosurg Spine 2021; 34:632-641. [PMID: 33513577 DOI: 10.3171/2020.8.spine20965] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/07/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Degenerative cervical spondylotic myelopathy (CSM) is a major cause of spinal cord dysfunction with an unpredictable prognosis. Βiomarkers reflecting pathophysiological processes in CSM have been insufficiently investigated. It was hypothesized that preoperative cerebrospinal fluid (CSF) biomarker levels are altered in patients with CSM and correlate with neurological status and outcome. METHODS CSF biomarkers from patients with CSM and controls were analyzed with immunoassays. Spinal cord changes were evaluated with MRI. The American Spinal Cord Injury Association Impairment Scale, the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), and the EQ-5D questionnaire were applied prior to and 3 months after surgery. A p value < 0.05 was considered statistically significant. RESULTS Twenty consecutive CSM patients with a mean age of 67.7 ± 13 years and 63 controls with a mean age of 65.2 ± 14.5 years (p > 0.05) were included in the study. In the CSM subjects, CSF neurofilament light subunit (NF-L) and glial fibrillary acidic protein (GFAP) concentrations were higher (p < 0.05), whereas fatty acid-binding protein 3 (FABP3), soluble amyloid precursor proteins (sAPPα and sAPPβ), and amyloid β (Aβ) peptide (Aβ38, Aβ40, and Aβ42) concentrations were lower than in controls (p < 0.05). Aβ peptide levels correlated positively with symptom duration. Preoperative JOACMEQ lower extremity function and CSF NF-L levels correlated positively, and the JOACMEQ bladder function correlated negatively with sAPPα and sAPPβ (p < 0.05). CSF NF-L and FABP3 levels were higher in patients with improved outcome (EQ-5D visual analog scale difference > 20). CONCLUSIONS CSF biomarkers of glial and axonal damage, inflammation, and synaptic changes are altered in symptomatic CSM patients, indicating that axonal injury, astroglial activation, and Aβ dysmetabolism may be present in these individuals. These findings reflect CSM pathophysiology and may aid in prognostication. However, future studies including larger patient cohorts, postoperative biomarker data and imaging, and longer follow-up times are required to validate the present findings.
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Affiliation(s)
- Parmenion P Tsitsopoulos
- 1Department of Neuroscience, Section of Neurosurgery, Uppsala University, Uppsala, Sweden
- 2Department of Neurosurgery, Hippokratio General Hospital, Aristotle University School of Health Sciences, Faculty of Medicine, Thessaloniki, Greece
| | - Ulrika Holmström
- 1Department of Neuroscience, Section of Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Kaj Blennow
- 3Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy at the University of Gothenburg, Mölndal
- 4Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- 3Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy at the University of Gothenburg, Mölndal
- 4Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- 5Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London
- 6UK Dementia Research Institute at University College of London, United Kingdom; and
| | - Niklas Marklund
- 1Department of Neuroscience, Section of Neurosurgery, Uppsala University, Uppsala, Sweden
- 7Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Neurosurgery, Lund, Sweden
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Neural Cell Adhesion Molecule (NCAM) a Serum Biomarker Indicative for the Severity of Cervical Spondylotic Myelopathy. Clin Spine Surg 2020; 33:E178-E184. [PMID: 32039991 DOI: 10.1097/bsd.0000000000000952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN Peripheral blood samples were obtained from 25 patients with cervical spondylotic myelopathy (CSM) and 13 healthy volunteers. OBJECTIVES Our aim was to investigate the significance of neurodegenerative biomarkers in patients with CSM and correlate their expression with CSM severity. SUMMARY OF BACKGROUND DATA CSM is a common disorder involving chronic progressive compression of the cervical spinal resulting in progressive neurological impairment that ranges from mild tingling in the upper limbs to complete quadriplegia. However, the immunological background related to the neurodegenerative damage and its significance in CSM is still unclear. METHODS Protein expression profiles of 14 neurodegenerative biomarkers were measured by multiplex Luminex bead assay and further analyzed by group comparison statistics, correlation studies, and receiver-operating characteristic analysis. RESULTS Eleven of 14 biomarkers were significantly elevated in CSM patients as compared with healthy subjects (P<0.05). Specifically, the clinical severity of CSM on the scales of Nurick and modified Japanese Orthopedics Association scale (mJOA) was inversely related to neural cell adhesion molecule (NCAM) levels (r=-0.529, P=0.007; r=-0.519, P=0.001, respectively). CONCLUSIONS Serum level of neural cell adhesion molecule may serve as a diagnostic biomarker correlating with the severity of CSM.
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Duetzmann S, Pilatus U, Seifert V, Marquardt G, Setzer M. Ex vivo 1H MR spectroscopy and histology after experimental chronic spinal cord compression. JOURNAL OF SPINE SURGERY 2017; 3:176-183. [PMID: 28744498 DOI: 10.21037/jss.2017.05.08] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Proton magnetic resonance imaging (MRS) is used increasingly to image the spinal cord in compressive cervical myelopathy (CSM). However, detailed analyses of the underlying histomorphological changes leading to MRS alterations are still lacking. The aim of our study was to correlate neuroimaging and neuropathologic alterations in a rabbit myelopathy model. METHODS Chronic spinal cord compression was induced in a rabbit model (n=16) allowing for a gradual 270° compression of the spinal cord. Spinal cord compression core areas were divided into two samples for (A) 1H MRS and (B) histopathological analyses. Postoperatively the animals underwent a neurological examination twice a day and outcome was categorized in pattern of injury and amount of recovery. RESULTS Three groups were observed and categorized: (I) animals with severe deficits and no or minimal recovery; (II) animals with severe deficits and complete or almost complete recovery; (III) animals with mild to moderate deficits and a complete recovery. Significant differences in the lesioned spinal cords between the different recovery groups were found for N-acetyl-aspartate and choline. NAA/Cr was detected significantly (P<0.001, ANOVA) less in the group that did show permanent neurological deficits. To the contrary, choline was detected significantly (P<0.001, ANOVA) more in the group that did show permanent neurological deficits. Histologically the first group showed more apoptosis and necrosis than the second and third group. CONCLUSIONS MR spectroscopy (MRS) may be helpful for clinicians in improving the prognostic accuracy in cervical myelopathies since this method nicely reflects the extent and severity of spinal cord damage.
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Affiliation(s)
- Stephan Duetzmann
- Department of Neurosurgery, Central Research Facility, Goethe University, Frankfurt/Main, Germany
| | - Ulrich Pilatus
- Brain Imaging Center, Central Research Facility, Goethe University, Frankfurt/Main, Germany
| | - Volker Seifert
- Department of Neurosurgery, Central Research Facility, Goethe University, Frankfurt/Main, Germany
| | - Gerhard Marquardt
- Department of Neurosurgery, Central Research Facility, Goethe University, Frankfurt/Main, Germany
| | - Matthias Setzer
- Department of Neurosurgery, Central Research Facility, Goethe University, Frankfurt/Main, Germany
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Wolf H, Krall C, Pajenda G, Hajdu S, Widhalm H, Leitgeb J, Sarahrudi K. Preliminary findings on biomarker levels from extracerebral sources in patients undergoing trauma surgery: Potential implications for TBI outcome studies. Brain Inj 2016; 30:1220-5. [PMID: 27295302 DOI: 10.3109/02699052.2016.1170883] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Despite several experimental studies on the role of S100B and NSE in fractures, no studies on the influence of surgery on the biomarker serum levels have been performed yet. METHODS The serum levels of S100B and NSE were analysed in patients with fractures that were located in the spine (group 1, n = 35) or in the lower extremity (group 2, n = 32) pre- and post-operatively. RESULTS The mean S100B serum level showed a significant increase (p = 0.04) post-surgery in the patients of group 1. In patients undergoing acute surgery (< 24 hours) the mean S100B serum level was 0.23 ± 0.22 μg L(-1) pre-operatively and 1.24 ± 1.38 μg L(-1) post-operatively. Likewise, the mean S100B serum level significantly increased in group 2 after surgery (p < 0.0001). In this group patients undergoing acute surgery showed a mean S100B serum level of 0.23 ± 0.14 μg L(-1) and 1.11 ± 0.73 μg L(-1) pre- and post-operatively. CONCLUSION This study demonstrates significant alterations of the biomarker S100B serum levels in patients undergoing surgery. Higher S100B serum levels were found within 24 hours and might be related to the acute fracture. The NSE serum levels were unchanged and this biomarker may offer the probability to serve as a future outcome predictor in studies with patients with traumatic brain injury and additional extracerebral injuries.
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Affiliation(s)
- H Wolf
- a Department for Trauma Surgery , Medical University of Vienna , Vienna , Austria.,b Faculty of Health Care and Social Work, Department of Public Health , University of Trnava , Slovakia.,c INRO (International Neurotrauma Research Organisation) , Vienna , Austria
| | - C Krall
- b Faculty of Health Care and Social Work, Department of Public Health , University of Trnava , Slovakia.,d Department for Medical Statistics , Medical University of Vienna , Vienna , Austria
| | - G Pajenda
- a Department for Trauma Surgery , Medical University of Vienna , Vienna , Austria
| | - S Hajdu
- a Department for Trauma Surgery , Medical University of Vienna , Vienna , Austria
| | - H Widhalm
- a Department for Trauma Surgery , Medical University of Vienna , Vienna , Austria
| | - J Leitgeb
- a Department for Trauma Surgery , Medical University of Vienna , Vienna , Austria
| | - K Sarahrudi
- a Department for Trauma Surgery , Medical University of Vienna , Vienna , Austria
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The Next Generation of Biomarker Research in Spinal Cord Injury. Mol Neurobiol 2016; 54:1482-1499. [DOI: 10.1007/s12035-016-9757-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 01/26/2016] [Indexed: 12/14/2022]
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Kato S, Chikuda H, Ohya J, Hayakawa K, Takeshita K, Tanaka S, Ogata T. Phosphorylated neurofilament subunit levels in the serum of cervical compressive myelopathy patients. J Clin Neurosci 2015. [DOI: 10.1016/j.jocn.2015.03.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Cruz CD, Coelho A, Antunes-Lopes T, Cruz F. Biomarkers of spinal cord injury and ensuing bladder dysfunction. Adv Drug Deliv Rev 2015; 82-83:153-9. [PMID: 25446137 DOI: 10.1016/j.addr.2014.11.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 09/02/2014] [Accepted: 11/08/2014] [Indexed: 12/29/2022]
Abstract
During the acute phase of SCI, the extension and residual neurological deficits that will persist after the waning of the spinal shock period are difficult to estimate on clinical grounds. Therefore, objective biomarkers able to estimate the extension of the lesion and the degree of neurological recovery are of great importance. Research has been focused on the detection of structural neuronal and glial proteins that leak from damaged cells, inflammatory proteins recruited to remove necrotic debris and more accurate neuroimaging methods that are able to discriminate the extension and functional consequences of the SCI. Urinary biomarkers are also being investigated to estimate functional changes that typically affect bladder function following SCI which can endanger patient's life in the long run. Future studies are needed to precisely characterize the composition and function of the glial scar that appears in the area of SCI and repeals axonal growth, therefore preventing axonal rewiring.
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Szelényi A, Heukamp C, Seifert V, Marquardt G. S100B, intraoperative neuromonitoring findings and their relation to clinical outcome in surgically treated intradural spinal lesions. Acta Neurochir (Wien) 2014; 156:733-9. [PMID: 24390083 DOI: 10.1007/s00701-013-1969-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 12/04/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Neurophysiological monitoring (IOM) consisting of somatosensory (SEPs), muscle (MEPs) and spinal motor evoked (D-wave; spinal MEPs) potentials is used to indicate injury related to surgical treatment of intradural and intramedullary lesions. Combining spinal and muscle MEPs reliably predicts long-term motor deficit. If spinal MEPs recording is not possible, additional markers-e.g. S100B, a serum marker for glial injury-may be a helpful adjunct. Thus, serial serum S100B measurements were related to both the intraoperative IOM recordings and the long-term neurological outcome in patients surgically treated for cervical and thoracic intradural lesions. METHODS In 33 patients (9 men, 24 women, 54 ± 17 years) during intramedullary (8) or intradural (25) cervical or thoracic spinal surgeries significant intraoperative SEP-amplitude decrement >50 % or MEP loss and serial S100B serum concentration (perioperative days 0, 1-3, 5) were related to outcome (>1 year after discharge, grouped into improved and unchanged/altered neurological symptoms). RESULTS Differences in S100B levels between patients with improved and unchanged/altered neurological outcome were significantly on postoperative days 2 (0.085 ± 0.08 μg/l vs 0.206 ± 0.07 μg/l, p = 0.005) and 3 (0.076 ± 0.03 μg/l vs 0.12 ± 0.05 μg/l, p = 0.007). All patients with permanent altered neurological symptoms developed S100B levels >0.08 μg/l (0.09-0.35 μg/l). Eighty-one percent of patients with improved neurological symptoms presented with S100B levels ≤0.08 μg/l (0.02-0.08 μg/l). Nine out of ten patients (90 %) without changes in EP and S100B had an improved long-term outcome, whereas 9/13 patients (69 %) with changes in EP and S100B had altered neurological symptoms in long-term outcome. CONCLUSION Intraoperative stable EPs and S100B ≤0.08 μg/l may be used as a marker to predict long-term neurological improvement, whereas EP-changes and elevated S100B levels on the 3rd postoperative day may be useful as a marker to predict long-term neurological alteration. In summary, the combined use of S100B and EPs might be helpful in the prediction of the severity of adverse spinal cord affection following surgery and guidance of patients.
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Lili X, Zhiyong H, Jianjun S. A preliminary study of the effects of ulinastatin on early postoperative cognition function in patients undergoing abdominal surgery. Neurosci Lett 2013; 541:15-9. [DOI: 10.1016/j.neulet.2013.02.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 02/04/2013] [Accepted: 02/05/2013] [Indexed: 10/27/2022]
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Yokobori S, Zhang Z, Moghieb A, Mondello S, Gajavelli S, Dietrich WD, Bramlett H, Hayes RL, Wang M, Wang KKW, Bullock MR. Acute diagnostic biomarkers for spinal cord injury: review of the literature and preliminary research report. World Neurosurg 2013; 83:867-78. [PMID: 23524031 DOI: 10.1016/j.wneu.2013.03.012] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 01/23/2013] [Accepted: 03/08/2013] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Many efforts have been made to create new diagnostic technologies for use in the diagnosis of central nervous system injury. However, there is still no consensus for the use of biomarkers in clinical acute spinal cord injury (SCI). The aims of this review are (1) to evaluate the current status of neurochemical biomarkers and (2) to discuss their potential acute diagnostic role in SCI by reviewing the literature. METHODS PubMed (http://www.ncbi.nlm.nih.gov/pubmed) was searched up to 2012 to identify publications concerning diagnostic biomarkers in SCI. To support more knowledge, we also checked secondary references in the primarily retrieved literature. RESULTS Neurofilaments, cleaved-Tau, microtubule-associated protein 2, myelin basic protein, neuron-specific enolase, S100β, and glial fibrillary acidic protein were identified as structural protein biomarkers in SCI by this review process. We could not find reports relating ubiquitin C-terminal hydrolase-L1 and α-II spectrin breakdown products, which are widely researched in other central nervous system injuries. Therefore, we present our preliminary data relating to these two biomarkers. Some of biomarkers showed promising results for SCI diagnosis and outcome prediction; however, there were unresolved issues relating to accuracy and their accessibility. CONCLUSION Currently, there still are not many reports focused on diagnostic biomarkers in SCI. This fact warranted the need for greater efforts to innovate sensitive and reliable biomarkers for SCI.
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Affiliation(s)
- Shoji Yokobori
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA; Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan.
| | - Zhiqun Zhang
- Departments of Psychiatry and Neuroscience, University of Florida, Gainesville, Florida, USA
| | - Ahmed Moghieb
- Departments of Psychiatry and Neuroscience, University of Florida, Gainesville, Florida, USA
| | | | - Shyam Gajavelli
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - W Dalton Dietrich
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Helen Bramlett
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - Michael Wang
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Kevin K W Wang
- Departments of Psychiatry and Neuroscience, University of Florida, Gainesville, Florida, USA
| | - M Ross Bullock
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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Cata JP, Abdelmalak B, Farag E. Neurological biomarkers in the perioperative period. Br J Anaesth 2011; 107:844-58. [PMID: 22065690 DOI: 10.1093/bja/aer338] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The rapid detection and evaluation of patients presenting with perioperative neurological dysfunction is of great clinical relevance. Biomarkers have been defined as biological molecules that can be used as an indicator of new onset or progression of a biological process or effect of treatment. Biomarkers have become increasingly important in this setting to supplement other modalities of diagnosis such as EEG, sensory- or motor-evoked potential, transcranial Doppler, near-infrared spectroscopy, or imaging methods. A number of neuro-proteins have been identified and are currently under investigation for potential to provide insights into injury severity, outcome, and the ability to monitor cellular damage and molecular events that occur during neurological injury. S100B is a protein released by glial cells and is considered a marker of blood-brain barrier dysfunction. Clinical studies in patients undergoing cardiac and non-cardiac surgery indicate that serum levels of S100B are increased intraoperatively and after operation. The neurone-specific enolase has also been extensively investigated as a potential marker of neuronal injury in the context of cardiac and non-cardiac surgery. A third biomarker of interest is the Tau protein, which has been linked to neurodegenerative disorders. Tau appears to be more specific than the previous two biomarkers since it is only found in the central nervous system. The metalloproteinase and ubiquitin C terminal hydroxylase-L1 (UCH-L1) are the most recently researched markers; however, their usefulness is still unclear. This review presents a comprehensive overview of S100B, neuronal-specific enolase, metalloproteinases, and UCH-L1 in the perioperative period.
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Affiliation(s)
- J P Cata
- Department of Anaesthesiology and Perioperative Medicine, The University of Texas-MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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Hyperphosphorylated neurofilament NF-H as a biomarker of the efficacy of minocycline therapy for spinal cord injury. Spinal Cord 2010; 49:333-6. [DOI: 10.1038/sc.2010.116] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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