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Ukachukwu AEK, Nischal SA, Trillo-Ordonez Y, Nwaribe EE, Abu-Bonsrah N, Malomo TA, Oyemolade TA, Badejo OA, Deng DD, Still MEH, Oboh EC, Okere OE, Asemota I, Oboh EN, Ogundeji OD, Ugorji C, Rahman R, Reddy P, Seas A, Waguia-Kouam R, von Isenburg M, Fuller AT, Haglund MM, Adeleye AO. Epidemiological Burden of Neurotrauma in Nigeria: A Systematic Review and Pooled Analysis of 45,763 Patients. World Neurosurg 2024; 185:e99-e142. [PMID: 38741332 DOI: 10.1016/j.wneu.2023.11.070] [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: 06/13/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 05/16/2024]
Abstract
OBJECTIVE Neurotrauma is a significant cause of morbidity and mortality in Nigeria. We conducted this systematic review to generate nationally generalizable reference data for the country. METHODS Four research databases and gray literature sources were electronically searched. Risk of bias was assessed using the Risk of Bias in Non-Randomized Studies of Interventions and Cochrane's risk of bias tools. Descriptive analysis, narrative synthesis, and statistical analysis (via paired t-tests and χ2 independence tests) were performed on relevant article metrics (α = 0.05). RESULTS We identified a cohort of 45,763 patients from 254 articles. The overall risk of bias was moderate to high. Most articles employed retrospective cohort study designs (37.4%) and were published during the last 2 decades (81.89%). The cohort's average age was 32.5 years (standard deviation, 20.2) with a gender split of ∼3 males per female. Almost 90% of subjects were diagnosed with traumatic brain injury, with road traffic accidents (68.6%) being the greatest cause. Altered consciousness (48.4%) was the most commonly reported clinical feature. Computed tomography (53.5%) was the most commonly used imaging modality, with skull (25.7%) and vertebral fracture (14.1%) being the most common radiological findings for traumatic brain injury and traumatic spinal injury, respectively. Two-thirds of patients were treated nonoperatively. Outcomes were favorable in 63.7% of traumatic brain injury patients, but in only 20.9% of traumatic spinal injury patients. Pressure sores, infection, and motor deficits were the most commonly reported complications in the latter. CONCLUSIONS This systematic review and pooled analysis demonstrate the significant burden of neurotrauma across Nigeria.
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Affiliation(s)
- Alvan-Emeka K Ukachukwu
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Health System, Durham, North Carolina, USA.
| | - Shiva A Nischal
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Yesel Trillo-Ordonez
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA
| | | | - Nancy Abu-Bonsrah
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Toluyemi A Malomo
- Department of Neuroscience, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Oluwakemi A Badejo
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
| | - Di D Deng
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA
| | - Megan E H Still
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Ena C Oboh
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA
| | | | - Isaac Asemota
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA
| | - Ehita N Oboh
- Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA
| | - Olaniyi D Ogundeji
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA
| | - Chiazam Ugorji
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA
| | - Raphia Rahman
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA
| | - Padmavathi Reddy
- University of Florida College of Medicine, Gainesville, Florida, USA
| | - Andreas Seas
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Duke University Pratt School of Engineering, Durham, North Carolina, USA; Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Megan von Isenburg
- Duke University Medical Center Library and Archives, Durham, North Carolina, USA
| | - Anthony T Fuller
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Health System, Durham, North Carolina, USA; Duke University Global Health Institute, Durham, North Carolina, USA
| | - Michael M Haglund
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Health System, Durham, North Carolina, USA; Duke University Global Health Institute, Durham, North Carolina, USA
| | - Amos O Adeleye
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
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Abd-Elsayed A, Robinson CL, Shehata P, Koh Y, Patel M, Fiala KJ. Neuromodulation's Role in Functional Restoration in Paraplegic and Quadriplegic Patients. Biomedicines 2024; 12:720. [PMID: 38672076 PMCID: PMC11047848 DOI: 10.3390/biomedicines12040720] [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: 01/29/2024] [Revised: 03/09/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024] Open
Abstract
Neuromodulation is an alternative, minimally invasive treatment option that, at times, is used as a last resort for chronic pain conditions that are often refractory to other treatment modalities. Moreover, it offers promising prospects for individuals grappling with the formidable challenges posed by paraplegia and quadriplegia resulting from spinal cord injuries. This review article provides a comprehensive assessment of current treatment modalities specifically tailored for paraplegic and quadriplegic patients. We aim to evaluate the existing surgical and non-surgical interventions while delving into the role of neuromodulation in the restoration of function for individuals afflicted with these debilitating conditions. Additionally, we review the efficacy, limitations, and comparative outcomes of diverse treatment strategies available for the management of paraplegia and quadriplegia. Emphasizing the critical need for effective interventions beyond the initial 24 h surgical window, we elucidate the challenges associated with conventional therapies and their limited success in achieving comprehensive functional restoration. Central to this review is an in-depth exploration of neuromodulation's transformative potential in ameliorating the deficits caused by spinal cord injuries. With a particular focus on spinal cord stimulation (SCS), we analyze and compare the outcomes of neuromodulation modalities and traditional treatment regimens, shedding light on the promising strides made in fostering sensory perception, motor function, and patient satisfaction.
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Affiliation(s)
- Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA; (P.S.); (Y.K.); (M.P.); (K.J.F.)
| | - Christopher L. Robinson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA 02115, USA;
| | - Peter Shehata
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA; (P.S.); (Y.K.); (M.P.); (K.J.F.)
| | - Yerin Koh
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA; (P.S.); (Y.K.); (M.P.); (K.J.F.)
| | - Milan Patel
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA; (P.S.); (Y.K.); (M.P.); (K.J.F.)
| | - Kenneth J. Fiala
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA; (P.S.); (Y.K.); (M.P.); (K.J.F.)
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Pozin M, Najafali D, Naik A, MacInnis B, Subbarao N, Zuckerman SL, Arnold PM. Long-term assessment of the functional independence measure in sports-related spinal cord injury. J Spinal Cord Med 2024; 47:214-228. [PMID: 36977319 PMCID: PMC10885752 DOI: 10.1080/10790268.2023.2167903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
CONTEXT Patients with spinal cord injury (SCI) secondary to traumatic sports-related etiology potentially face loss of independence. The Functional Independence Measure (FIM) assesses the amount of assistance patients require and has shown sensitivity to changes in patient functional status post injury. OBJECTIVES We aimed to (1) examine long-term outcomes following sports-related SCI (SRSCI) using FIM scoring at the time of injury, one year, and five years post-injury, and (2) determine predictors of independence at one and five-year follow-up considering surgical and non-surgical management. Few studies have investigated the cohort analyzed in this study. METHODS The 1973-2016 National Spinal Cord Injury Model Systems (SCIMS) Database was used to develop a SRSCI cohort. The primary outcome of interest captured functional independence using a multivariate logistic regression, defined by FIM individual scores greater than or equal to six, evaluated at one and five years. RESULTS A total of 491 patients were analyzed, 60 (12%) were female, 452 (92%) underwent surgery. The cohort demographics were stratified by patients with and without spine surgery and evaluated for functional independence in FIM subcategories. Increased time spent in inpatient rehabilitation and FIM score at post-operative discharge were associated with greater likelihood of functional ability at both one and five-year follow-up. CONCLUSION Our study demonstrated that SRSCI patients are a unique subset of SCI patients for whom factors repeatedly associated with independence at one year follow-up were dissimilar to those associated with independence at five-year follow-up. Larger prospective studies should be conducted to establish guidelines for this unique subcategory of SCI patients.
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Affiliation(s)
- Michael Pozin
- Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana, Illinois, USA
| | - Daniel Najafali
- Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana, Illinois, USA
| | - Anant Naik
- Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana, Illinois, USA
| | - Bailey MacInnis
- Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana, Illinois, USA
| | - Natasha Subbarao
- Kansas City University College of Medicine, Joplin, Missouri, USA
| | - Scott L. Zuckerman
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Paul M. Arnold
- Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana, Illinois, USA
- Department of Neurosurgery, Carle Foundation Hospital, Urbana, Illinois, USA
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Miron RJ, Estrin NE, Sculean A, Zhang Y. Understanding exosomes: Part 2-Emerging leaders in regenerative medicine. Periodontol 2000 2024; 94:257-414. [PMID: 38591622 DOI: 10.1111/prd.12561] [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: 02/04/2024] [Revised: 02/16/2024] [Accepted: 02/21/2024] [Indexed: 04/10/2024]
Abstract
Exosomes are the smallest subset of extracellular signaling vesicles secreted by most cells with the ability to communicate with other tissues and cell types over long distances. Their use in regenerative medicine has gained tremendous momentum recently due to their ability to be utilized as therapeutic options for a wide array of diseases/conditions. Over 5000 publications are currently being published yearly on this topic, and this number is only expected to dramatically increase as novel therapeutic strategies continue to be developed. Today exosomes have been applied in numerous contexts including neurodegenerative disorders (Alzheimer's disease, central nervous system, depression, multiple sclerosis, Parkinson's disease, post-traumatic stress disorders, traumatic brain injury, peripheral nerve injury), damaged organs (heart, kidney, liver, stroke, myocardial infarctions, myocardial infarctions, ovaries), degenerative processes (atherosclerosis, diabetes, hematology disorders, musculoskeletal degeneration, osteoradionecrosis, respiratory disease), infectious diseases (COVID-19, hepatitis), regenerative procedures (antiaging, bone regeneration, cartilage/joint regeneration, osteoarthritis, cutaneous wounds, dental regeneration, dermatology/skin regeneration, erectile dysfunction, hair regrowth, intervertebral disc repair, spinal cord injury, vascular regeneration), and cancer therapy (breast, colorectal, gastric cancer and osteosarcomas), immune function (allergy, autoimmune disorders, immune regulation, inflammatory diseases, lupus, rheumatoid arthritis). This scoping review is a first of its kind aimed at summarizing the extensive regenerative potential of exosomes over a broad range of diseases and disorders.
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Affiliation(s)
- Richard J Miron
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Nathan E Estrin
- Advanced PRF Education, Venice, Florida, USA
- School of Dental Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, Florida, USA
| | - Anton Sculean
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Yufeng Zhang
- Department of Oral Implantology, University of Wuhan, Wuhan, China
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Wei Z, Yu H, Zhao H, Wei M, Xing H, Pei J, Yang Y, Ren K. Broadening horizons: ferroptosis as a new target for traumatic brain injury. BURNS & TRAUMA 2024; 12:tkad051. [PMID: 38250705 PMCID: PMC10799763 DOI: 10.1093/burnst/tkad051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/24/2023] [Accepted: 10/15/2023] [Indexed: 01/23/2024]
Abstract
Traumatic brain injury (TBI) is a leading cause of death and disability worldwide, with ~50 million people experiencing TBI each year. Ferroptosis, a form of regulated cell death triggered by iron ion-catalyzed and reactive oxygen species-induced lipid peroxidation, has been identified as a potential contributor to traumatic central nervous system conditions, suggesting its involvement in the pathogenesis of TBI. Alterations in iron metabolism play a crucial role in secondary injury following TBI. This study aimed to explore the role of ferroptosis in TBI, focusing on iron metabolism disorders, lipid metabolism disorders and the regulatory axis of system Xc-/glutathione/glutathione peroxidase 4 in TBI. Additionally, we examined the involvement of ferroptosis in the chronic TBI stage. Based on these findings, we discuss potential therapeutic interventions targeting ferroptosis after TBI. In conclusion, this review provides novel insights into the pathology of TBI and proposes potential therapeutic targets.
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Affiliation(s)
- Ziqing Wei
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Road, Erqi District, Zhengzhou, China
- Henan Key Laboratory of Cerebrovascular Diseases, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Road, Erqi District, Zhengzhou, China
- Clinical Systems Biology Laboratories, The First Affiliated Hospital of Zhengzhou University, No. 1, Longhu Middle Ring Road, Jinshui District, Zhengzhou, China
| | - Haihan Yu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Road, Erqi District, Zhengzhou, China
| | - Huijuan Zhao
- Henan International Joint Laboratory of Thrombosis and Hemostasis, College of Basic Medicine and Forensic Medicine, Henan University of Science and Technology, No. 1, Longhu Middle Ring Road, Jinshui District, Luoyang, China
| | - Mingze Wei
- The Second Clinical Medical College, Harbin Medical University, No. 263, Kaiyuan Avenue, Luolong District, Harbin, China
| | - Han Xing
- Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, No. 246, Xuefu Road, Nangang District, Zhengzhou 450052, China
- Henan Key Laboratory of Precision Clinical Pharmacy, Zhengzhou University, No. 1, Jianshe East Road, Erqi District, Zhengzhou 450052, China
| | - Jinyan Pei
- Quality Management Department, Henan No.3 Provincial People’s Hospital, No. 198, Funiu Road, Zhongyuan District, Henan province, Zhengzhou 450052, China
| | - Yang Yang
- Clinical Systems Biology Research Laboratories, Translational Medicine Center, the First Affiliated Hospital of Zhengzhou University, No. 198, Funiu Road, Zhongyuan District, Zhengzhou 450052, China
| | - Kaidi Ren
- Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, No. 246, Xuefu Road, Nangang District, Zhengzhou 450052, China
- Henan Key Laboratory of Precision Clinical Pharmacy, Zhengzhou University, No. 1, Jianshe East Road, Erqi District, Zhengzhou 450052, China
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Jang K, Garraway SM. A review of dorsal root ganglia and primary sensory neuron plasticity mediating inflammatory and chronic neuropathic pain. NEUROBIOLOGY OF PAIN (CAMBRIDGE, MASS.) 2024; 15:100151. [PMID: 38314104 PMCID: PMC10837099 DOI: 10.1016/j.ynpai.2024.100151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/04/2024] [Accepted: 01/19/2024] [Indexed: 02/06/2024]
Abstract
Pain is a sensory state resulting from complex integration of peripheral nociceptive inputs and central processing. Pain consists of adaptive pain that is acute and beneficial for healing and maladaptive pain that is often persistent and pathological. Pain is indeed heterogeneous, and can be expressed as nociceptive, inflammatory, or neuropathic in nature. Neuropathic pain is an example of maladaptive pain that occurs after spinal cord injury (SCI), which triggers a wide range of neural plasticity. The nociceptive processing that underlies pain hypersensitivity is well-studied in the spinal cord. However, recent investigations show maladaptive plasticity that leads to pain, including neuropathic pain after SCI, also exists at peripheral sites, such as the dorsal root ganglia (DRG), which contains the cell bodies of sensory neurons. This review discusses the important role DRGs play in nociceptive processing that underlies inflammatory and neuropathic pain. Specifically, it highlights nociceptor hyperexcitability as critical to increased pain states. Furthermore, it reviews prior literature on glutamate and glutamate receptors, voltage-gated sodium channels (VGSC), and brain-derived neurotrophic factor (BDNF) signaling in the DRG as important contributors to inflammatory and neuropathic pain. We previously reviewed BDNF's role as a bidirectional neuromodulator of spinal plasticity. Here, we shift focus to the periphery and discuss BDNF-TrkB expression on nociceptors, non-nociceptor sensory neurons, and non-neuronal cells in the periphery as a potential contributor to induction and persistence of pain after SCI. Overall, this review presents a comprehensive evaluation of large bodies of work that individually focus on pain, DRG, BDNF, and SCI, to understand their interaction in nociceptive processing.
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Affiliation(s)
- Kyeongran Jang
- Department of Cell Biology, Emory University, School of Medicine, Atlanta, GA, 30322, USA
| | - Sandra M. Garraway
- Department of Cell Biology, Emory University, School of Medicine, Atlanta, GA, 30322, USA
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Msheik A, Abbass D, Bayram M, Awde A, Al Mokdad Z. Cervical Myelocystocele: A One-in-50,000 Congenital Abnormality of the Spinal Cord. Cureus 2023; 15:e37278. [PMID: 37168187 PMCID: PMC10165719 DOI: 10.7759/cureus.37278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2023] [Indexed: 05/13/2023] Open
Abstract
Neural tube defects are a group of birth defects that affect the development of the spinal cord and brain. Myelomeningocele is a type of neural tube defect that results in the protrusion of the spinal cord and meninges through a defect in the vertebral column. While myelomeningocele is a relatively rare condition, cervical myelomeningocele is extremely uncommon. The condition can lead to various neurological problems and atrophies and is typically diagnosed in the first trimester of pregnancy using an ultrasound examination. Surgical intervention is typically recommended to repair the affected vertebral column. In this report, we describe the case of a four-month-old baby boy who was diagnosed with a cervical myelocystocele and successfully treated surgically. The patient had an excellent postoperative status, and this case highlights the importance of early diagnosis and intervention in the management of this rare condition.
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Affiliation(s)
- Ali Msheik
- Neurological Surgery, Zahraa Hospital University Medical Center, Beirut, LBN
- Neurological Surgery, Lebanese University Faculty of Medical Sciences, Hadath, LBN
| | - Daniel Abbass
- Neurological Surgery, Al Rassoul Al-Aazam Hospital, Beirut, LBN
| | - Mohamad Bayram
- Neurological Surgery, Al Rassoul Al-Aazam Hospital, Beirut, LBN
| | - Ahmad Awde
- Neurosurgery, Endovascular Neurosurgery, Al Rassoul Al-Aazam Hospital, Beirut, LBN
| | - Zeinab Al Mokdad
- Medical Sciences, Public Health, Lebanese University Faculty of Medical Sciences, Hadath, LBN
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Lim YJ, Jung GN, Park WT, Seo MS, Lee GW. Therapeutic potential of small extracellular vesicles derived from mesenchymal stem cells for spinal cord and nerve injury. Front Cell Dev Biol 2023; 11:1151357. [PMID: 37035240 PMCID: PMC10073723 DOI: 10.3389/fcell.2023.1151357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 03/10/2023] [Indexed: 04/11/2023] Open
Abstract
Neural diseases such as compressive, congenital, and traumatic injuries have diverse consequences, from benign mild sequelae to severe life-threatening conditions with associated losses of motor, sensory, and autonomic functions. Several approaches have been adopted to control neuroinflammatory cascades. Traditionally, mesenchymal stem cells (MSCs) have been regarded as therapeutic agents, as they possess growth factors and cytokines with potential anti-inflammatory and regenerative effects. However, several animal model studies have reported conflicting outcomes, and therefore, the role of MSCs as a regenerative source for the treatment of neural pathologies remains debatable. In addition, issues such as heterogeneity and ethical issues limited their use as therapeutic agents. To overcome the obstacles associated with the use of traditional agents, we explored the therapeutic potentials of extracellular vesicles (EVs), which contain nucleic acids, functional proteins, and bioactive lipids, and play crucial roles in immune response regulation, inflammation reduction, and cell-to-cell communication. EVs may surpass MSCs in size issue, immunogenicity, and response to the host environment. However, a comprehensive review is required on the therapeutic potential of EVs for the treatment of neural pathologies. In this review, we discuss the action mechanism of EVs, their potential for treating neural pathologies, and future perspectives regarding their clinical applications.
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Affiliation(s)
- Young-Ju Lim
- Department of Orthopedic Surgery, Yeungnam University College of Medicine, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Gyeong Na Jung
- Department of Orthopedic Surgery, Yeungnam University College of Medicine, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Wook-Tae Park
- Department of Orthopedic Surgery, Yeungnam University College of Medicine, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Min-Soo Seo
- Department of Veterinary Tissue Engineering, College of Veterinary Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Gun Woo Lee
- Department of Orthopedic Surgery, Yeungnam University College of Medicine, Yeungnam University Medical Center, Daegu, Republic of Korea
- *Correspondence: Gun Woo Lee,
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Blando S, Anchesi I, Mazzon E, Gugliandolo A. Can a Scaffold Enriched with Mesenchymal Stem Cells Be a Good Treatment for Spinal Cord Injury? Int J Mol Sci 2022; 23:ijms23147545. [PMID: 35886890 PMCID: PMC9319719 DOI: 10.3390/ijms23147545] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/01/2022] [Accepted: 07/05/2022] [Indexed: 12/10/2022] Open
Abstract
Spinal cord injury (SCI) is a worldwide highly crippling disease that can lead to the loss of motor and sensory neurons. Among the most promising therapies, there are new techniques of tissue engineering based on stem cells that promote neuronal regeneration. Among the different types of stem cells, mesenchymal stem cells (MSCs) seem the most promising. Indeed, MSCs are able to release trophic factors and to differentiate into the cell types that can be found in the spinal cord. Currently, the most common procedure to insert cells in the lesion site is infusion. However, this causes a low rate of survival and engraftment in the lesion site. For these reasons, tissue engineering is focusing on bioresorbable scaffolds to help the cells to stay in situ. Scaffolds do not only have a passive role but become fundamental for the trophic support of cells and the promotion of neuroregeneration. More and more types of materials are being studied as scaffolds to decrease inflammation and increase the engraftment as well as the survival of the cells. Our review aims to highlight how the use of scaffolds made from biomaterials enriched with MSCs gives positive results in in vivo SCI models as well as the first evidence obtained in clinical trials.
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Patel PD, Divi SN, Canseco JA, Donnally CJ, Galetta M, Vaccaro A, Schroeder GD, Hsu WK, Hecht AC, Dossett AB, Dhanota AS, Prasad SK, Vaccaro AR. Management of Acute Subaxial Trauma and Spinal Cord Injury in Professional Collision Athletes. Clin Spine Surg 2022; 35:241-248. [PMID: 34379610 DOI: 10.1097/bsd.0000000000001148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 11/07/2020] [Indexed: 11/25/2022]
Abstract
Sports-related acute cervical trauma and spinal cord injury (SCI) represent a rare but devastating potential complication of collision sport injuries. Currently, there is debate on appropriate management protocols and return-to-play guidelines in professional collision athletes following cervical trauma. While cervical muscle strains and sprains are among the most common injuries sustained by collision athletes, the life-changing effects of severe neurological sequelae (ie, quadriplegia and paraplegia) from fractures and SCIs require increased attention and care. Appropriate on-field management and subsequent transfer/workup at an experienced trauma/SCI center is necessary for optimal patient care, prevention of injury exacerbation, and improvement in outcomes. This review discusses the epidemiology, pathophysiology, clinical presentation, immediate/long-term management, and current return-to-play recommendations of athletes who suffer cervical trauma and SCI.
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Affiliation(s)
- Parthik D Patel
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Phiadelphia, PA
| | - Srikanth N Divi
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Phiadelphia, PA
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Phiadelphia, PA
| | - Chester J Donnally
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Phiadelphia, PA
| | - Matthew Galetta
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Phiadelphia, PA
| | - Alexander Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Phiadelphia, PA
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Phiadelphia, PA
| | - Wellington K Hsu
- Department of Orthopaedic Srugery, Northwestern University, Chicago, IL
| | - Andrew C Hecht
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Andrew B Dossett
- Department of Orthopaedic Surgery, The Carrell Clinic, Dallas, TX
| | - Arsh S Dhanota
- Department of Sports Medicine, Perelman School of Medicine at the University of Pennsylvania
| | - Srivinas K Prasad
- Department of Neurosurgery, Thomas Jefferson University, Phiadelphia, PA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Phiadelphia, PA
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Electroacupuncture for Spinal Cord Injury: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:8040555. [PMID: 35280510 PMCID: PMC8916891 DOI: 10.1155/2022/8040555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 11/29/2021] [Indexed: 11/28/2022]
Abstract
Background Previous studies have shown that electroacupuncture (EA) has a positive effect on motor and sensory function in patients with spinal cord injury (SCI). This review evaluated the effectiveness of EA for improvement in activities of daily living in patients with SCI. Methods We searched the Cochrane Library, PubMed, Web of Science, CNKI, WanFang Data, and VIP databases using a search strategy according to the guidelines of the Cochrane Handbook for Systematic Review of Interventions up to 30th September 2020. Only randomized controlled trials (RCTs) of EA in patients with SCI were included. We analyzed the data using RevMan (version 5.3) and graded the quality of evidence using GRADE profiler 3.6.1. Results This meta-analysis included 10 RCTs with 712 patients. Three studies revealed that the functional independence measure score for SCI patients in the EA group was higher than that in the control group (mean difference [MD] = 13.46, 95% CI: 8.00 to 18.92, P < 0.00001). Five studies showed that the modified Barthel index in the EA group was higher than that in the control group (MD = 6.92, 95% CI: 4.96 to 8.89, P < 0.00001). Five studies showed that the American Spinal Injury Association-motor score (ASIA-motor score) in the EA group was higher than that in the control group (standard MD = 0.96, 95% CI: 0.75 to 1.18, P < 0.00001). Three studies reported the ASIA-tactile and pain scores and also reported that the scores in the EA group were higher than those in the control group, with high homogeneity (tactile I2 = 86%, P = 0.0008; pain I2 = 54%, P = 0.11). The quality of evidence for the use of EA for improvement in motor and sensory function in SCIs was moderate according to the GRADE system. Conclusion This review suggested that EA improves activities of daily living and motor function in patients with SCI, with a moderate level of evidence.
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Wang TY, Park C, Zhang H, Rahimpour S, Murphy KR, Goodwin CR, Karikari IO, Than KD, Shaffrey CI, Foster N, Abd-El-Barr MM. Management of Acute Traumatic Spinal Cord Injury: A Review of the Literature. Front Surg 2021; 8:698736. [PMID: 34966774 PMCID: PMC8710452 DOI: 10.3389/fsurg.2021.698736] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 11/19/2021] [Indexed: 11/27/2022] Open
Abstract
Traumatic spinal cord injury (TSCI) is a debilitating disease that poses significant functional and economic burden on both the individual and societal levels. Prognosis is dependent on the extent of the spinal injury and the severity of neurological dysfunction. If not treated rapidly, patients with TSCI can suffer further secondary damage and experience escalating disability and complications. It is important to quickly assess the patient to identify the location and severity of injury to make a decision to pursue a surgical and/or conservative management. However, there are many conditions that factor into the management of TSCI patients, ranging from the initial presentation of the patient to long-term care for optimal recovery. Here, we provide a comprehensive review of the etiologies of spinal cord injury and the complications that may arise, and present an algorithm to aid in the management of TSCI.
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Affiliation(s)
- Timothy Y Wang
- Department of Neurological Surgery, Duke University Medical Center, Durham, NC, United States
| | - Christine Park
- Department of Neurological Surgery, Duke University Medical Center, Durham, NC, United States
| | - Hanci Zhang
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC, United States
| | - Shervin Rahimpour
- Department of Neurological Surgery, Duke University Medical Center, Durham, NC, United States
| | - Kelly R Murphy
- Department of Neurological Surgery, Duke University Medical Center, Durham, NC, United States
| | - C Rory Goodwin
- Department of Neurological Surgery, Duke University Medical Center, Durham, NC, United States
| | - Isaac O Karikari
- Department of Neurological Surgery, Duke University Medical Center, Durham, NC, United States
| | - Khoi D Than
- Department of Neurological Surgery, Duke University Medical Center, Durham, NC, United States
| | - Christopher I Shaffrey
- Department of Neurological Surgery, Duke University Medical Center, Durham, NC, United States
| | - Norah Foster
- Premier Orthopedics, Centerville, OH, United States
| | - Muhammad M Abd-El-Barr
- Department of Neurological Surgery, Duke University Medical Center, Durham, NC, United States
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Kim GU, Sung SE, Kang KK, Choi JH, Lee S, Sung M, Yang SY, Kim SK, Kim YI, Lim JH, Seo MS, Lee GW. Therapeutic Potential of Mesenchymal Stem Cells (MSCs) and MSC-Derived Extracellular Vesicles for the Treatment of Spinal Cord Injury. Int J Mol Sci 2021; 22:ijms222413672. [PMID: 34948463 PMCID: PMC8703906 DOI: 10.3390/ijms222413672] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/14/2021] [Accepted: 12/18/2021] [Indexed: 12/15/2022] Open
Abstract
Spinal cord injury (SCI) is a life-threatening condition that leads to permanent disability with partial or complete loss of motor, sensory, and autonomic functions. SCI is usually caused by initial mechanical insult, followed by a cascade of several neuroinflammation and structural changes. For ameliorating the neuroinflammatory cascades, MSC has been regarded as a therapeutic agent. The animal SCI research has demonstrated that MSC can be a valuable therapeutic agent with several growth factors and cytokines that may induce anti-inflammatory and regenerative effects. However, the therapeutic efficacy of MSCs in animal SCI models is inconsistent, and the optimal method of MSCs remains debatable. Moreover, there are several limitations to developing these therapeutic agents for humans. Therefore, identifying novel agents for regenerative medicine is necessary. Extracellular vesicles are a novel source for regenerative medicine; they possess nucleic acids, functional proteins, and bioactive lipids and perform various functions, including damaged tissue repair, immune response regulation, and reduction of inflammation. MSC-derived exosomes have advantages over MSCs, including small dimensions, low immunogenicity, and no need for additional procedures for culture expansion or delivery. Certain studies have demonstrated that MSC-derived extracellular vesicles (EVs), including exosomes, exhibit outstanding chondroprotective and anti-inflammatory effects. Therefore, we reviewed the principles and patho-mechanisms and summarized the research outcomes of MSCs and MSC-derived EVs for SCI, reported to date.
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Affiliation(s)
- Gang-Un Kim
- Department of Orthopedic Surgery, Hanil General Hospital, 308 Uicheon-ro, Dobong-gu, Seoul 01450, Korea;
| | - Soo-Eun Sung
- Department of Laboratory Animal Center, Daegu-Gyeongbuk Medical Innovation Foundation (DGMIF), Daegu 41061, Korea; (S.-E.S.); (K.-K.K.); (J.-H.C.); (S.L.); (M.S.)
| | - Kyung-Ku Kang
- Department of Laboratory Animal Center, Daegu-Gyeongbuk Medical Innovation Foundation (DGMIF), Daegu 41061, Korea; (S.-E.S.); (K.-K.K.); (J.-H.C.); (S.L.); (M.S.)
| | - Joo-Hee Choi
- Department of Laboratory Animal Center, Daegu-Gyeongbuk Medical Innovation Foundation (DGMIF), Daegu 41061, Korea; (S.-E.S.); (K.-K.K.); (J.-H.C.); (S.L.); (M.S.)
| | - Sijoon Lee
- Department of Laboratory Animal Center, Daegu-Gyeongbuk Medical Innovation Foundation (DGMIF), Daegu 41061, Korea; (S.-E.S.); (K.-K.K.); (J.-H.C.); (S.L.); (M.S.)
| | - Minkyoung Sung
- Department of Laboratory Animal Center, Daegu-Gyeongbuk Medical Innovation Foundation (DGMIF), Daegu 41061, Korea; (S.-E.S.); (K.-K.K.); (J.-H.C.); (S.L.); (M.S.)
| | - Seung Yun Yang
- Department of Biomaterials Science, Life and Industry Convergence Institute, Pusan National University, Miryang 50463, Korea;
| | - Seul-Ki Kim
- Efficacy Evaluation Team, Food Science R&D Center, KolmarBNH CO., LTD, 61Heolleungro 8-gil, Seocho-gu, Seoul 06800, Korea;
| | | | - Ju-Hyeon Lim
- New Drug Development Center, Osong Medical Innovation Foundation, Chungbuk 28160, Korea;
- Department of Orthopedic Surgery, Yeungnam University College of Medicine, Yeungnam University Medical Center, 170 Hyonchung-ro, Namgu, Daegu 42415, Korea
| | - Min-Soo Seo
- Department of Laboratory Animal Center, Daegu-Gyeongbuk Medical Innovation Foundation (DGMIF), Daegu 41061, Korea; (S.-E.S.); (K.-K.K.); (J.-H.C.); (S.L.); (M.S.)
- Correspondence: (M.-S.S.); (G.W.L.); Tel.: +82-53-7905727 (M.S.S.); +82-53-6203642 (G.W.L.)
| | - Gun Woo Lee
- Cellexobio, Co. Ltd., Daegu 42415, Korea;
- Department of Orthopedic Surgery, Yeungnam University College of Medicine, Yeungnam University Medical Center, 170 Hyonchung-ro, Namgu, Daegu 42415, Korea
- Correspondence: (M.-S.S.); (G.W.L.); Tel.: +82-53-7905727 (M.S.S.); +82-53-6203642 (G.W.L.)
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Campos J, Silva NA, Salgado AJ. Nutritional interventions for spinal cord injury: preclinical efficacy and molecular mechanisms. Nutr Rev 2021; 80:1206-1221. [PMID: 34472615 DOI: 10.1093/nutrit/nuab068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Spinal cord injury (SCI) is a debilitating condition that leads to motor, sensory, and autonomic impairments. Its intrinsic pathophysiological complexity has hindered the establishment of effective treatments for decades. Nutritional interventions (NIs) for SCI have been proposed as a route to circumvent some of the problems associated with this condition. Results obtained in animal models point to a more holistic effect, rather than to specific modulation, of several relevant SCI pathophysiological processes. Indeed, published data have shown NI improves energetic imbalance, oxidative damage, and inflammation, which are promoters of improved proteostasis and neurotrophic signaling, leading ultimately to neuroprotection and neuroplasticity. This review focuses on the most well-documented Nis. The mechanistic implications and their translational potential for SCI are discussed.
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Affiliation(s)
- Jonas Campos
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Nuno A Silva
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - António J Salgado
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
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15
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Sykova E, Cizkova D, Kubinova S. Mesenchymal Stem Cells in Treatment of Spinal Cord Injury and Amyotrophic Lateral Sclerosis. Front Cell Dev Biol 2021; 9:695900. [PMID: 34295897 PMCID: PMC8290345 DOI: 10.3389/fcell.2021.695900] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/31/2021] [Indexed: 01/01/2023] Open
Abstract
Preclinical and clinical studies with various stem cells, their secretomes, and extracellular vesicles (EVs) indicate their use as a promising strategy for the treatment of various diseases and tissue defects, including neurodegenerative diseases such as spinal cord injury (SCI) and amyotrophic lateral sclerosis (ALS). Autologous and allogenic mesenchymal stem cells (MSCs) are so far the best candidates for use in regenerative medicine. Here we review the effects of the implantation of MSCs (progenitors of mesodermal origin) in animal models of SCI and ALS and in clinical studies. MSCs possess multilineage differentiation potential and are easily expandable in vitro. These cells, obtained from bone marrow (BM), adipose tissue, Wharton jelly, or even other tissues, have immunomodulatory and paracrine potential, releasing a number of cytokines and factors which inhibit the proliferation of T cells, B cells, and natural killer cells and modify dendritic cell activity. They are hypoimmunogenic, migrate toward lesion sites, induce better regeneration, preserve perineuronal nets, and stimulate neural plasticity. There is a wide use of MSC systemic application or MSCs seeded on scaffolds and tissue bridges made from various synthetic and natural biomaterials, including human decellularized extracellular matrix (ECM) or nanofibers. The positive effects of MSC implantation have been recorded in animals with SCI lesions and ALS. Moreover, promising effects of autologous as well as allogenic MSCs for the treatment of SCI and ALS were demonstrated in recent clinical studies.
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Affiliation(s)
- Eva Sykova
- Institute of Neuroimmunology, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Dasa Cizkova
- Institute of Neuroimmunology, Slovak Academy of Sciences, Bratislava, Slovakia.,Centre for Experimental and Clinical Regenerative Medicine, University of Veterinary Medicine and Pharmacy in Kosice, Kosice, Slovakia
| | - Sarka Kubinova
- Department of Optical and Biophysical Systems, Institute of Physics of the Czech Academy of Sciences, Prague, Czechia
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16
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Chu K, deSouza IS. An unusual case of burning hands. Am J Emerg Med 2021; 48:276-278. [PMID: 34022634 DOI: 10.1016/j.ajem.2021.05.026] [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: 03/06/2021] [Revised: 04/29/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022] Open
Abstract
Burning Hands Syndrome is an unusual variant of central cord syndrome. There have been few published reports, and none in the emergency medicine literature. We present a case of Burning Hands Syndrome in which there were no computed tomography (CT) findings of cervical spine injury and only subtle magnetic resonance (MR) abnormalities. We discuss the importance of early diagnosis, as the optimal management of these patients ultimately depends upon prompt recognition of the underlying cervical trauma and a spinal cord at risk for further injury.
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Affiliation(s)
- Kathy Chu
- Department of Emergency Medicine, SUNY Downstate Health Sciences University, Kings County Hospital Center, Brooklyn, New York, USA.
| | - Ian S deSouza
- Department of Emergency Medicine, SUNY Downstate Health Sciences University, Kings County Hospital Center, Brooklyn, New York, USA
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Ruddell JH, DePasse JM, Tang OY, Daniels AH. Timing of Surgery for Thoracolumbar Spine Trauma: Patients With Neurological Injury. Clin Spine Surg 2021; 34:E229-E236. [PMID: 33027090 DOI: 10.1097/bsd.0000000000001078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 07/24/2020] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN Large multicenter retrospective cohort study. OBJECTIVE The objective of this study was to analyze the effect of fusion timing on inpatient outcomes in a nationally representative population with thoracolumbar fracture and concurrent neurological injury. SUMMARY OF BACKGROUND DATA Among thoracolumbar trauma admissions, concurrent neurological injury is associated with greater long-term morbidity. There is little consensus on optimal surgical timing for these patients; previous investigations fail to differentiate thoracolumbar fracture with and without neurological injury. MATERIALS AND METHODS We analyzed 19,136 nonelective National Inpatient Sample cases (2004-2014) containing International Classifications of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes for closed thoracic/lumbar fracture with neurological injury and procedure codes for primary thoracolumbar/lumbosacral fusion, excluding open/cervical fracture. Timing classification from admission to fusion was same-day, 1-2-, 3-6-, and ≥7-day delay. Primary outcomes included in-hospital mortality, complications, and infection; secondary outcomes included total and postoperative length of stay and charges. Logistic regressions and generalized linear models with gamma distribution and log-link evaluated the effect of surgical timing on primary and secondary outcomes, respectively, controlling for age, sex, fracture location, fusion approach, multiorgan system injury severity score, and medical comorbidities. RESULTS Patients undergoing surgery ≤72 hours (n=12,845) had the lowest odds of in-hospital cardiac [odds ratio (OR)=0.595; 95% confidence interval (CI), 0.357-0.991] and respiratory complications (OR=0.495; 95% CI, 0.313-0.784) and infection (OR=0.615; 95% CI, 0.390-0.969). No differences were observed between same-day (n=4724) and 1-2-day delay (n=8121) (P>0.05). Lowest odds of hemorrhage or hematoma was observed following 3-6-day delay (OR=0.467; 95% CI, 0.236-0.922). A ≥7-day delay to fusion (n=2,002) was associated with greatest odds of hemorrhage/hematoma (OR=2.019; 1.107-3.683), respiratory complications (OR=1.850; 95% CI, 1.076-3.180), and infection (OR=3.155; 95% CI, 1.891-5.263) and greatest increases in mean postoperative length of stay (4.26% or 35.3% additional days) and charges (163,562 or 71.7% additional US dollars) (P<0.001). CONCLUSIONS Patients with thoracolumbar fracture and associated neurological injury who underwent surgery within 3 days of admission experienced fewer in-hospital complications. These benefits may be due to secondary injury mechanism avoidance and earlier mobilization. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | - J Mason DePasse
- Division of Spine, Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI
| | | | - Alan H Daniels
- Division of Spine, Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI
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18
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Comparison of Early Surgical Treatment With Conservative Treatment of Incomplete Cervical Spinal Cord Injury Without Major Fracture or Dislocation in Patients With Pre-existing Cervical Spinal Stenosis. Clin Spine Surg 2021; 34:E141-E146. [PMID: 32925187 DOI: 10.1097/bsd.0000000000001065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 07/24/2020] [Indexed: 11/27/2022]
Abstract
STUDY DESIGN This was a retrospective comparative study. OBJECTIVE The objective of this study was to evaluate the clinical outcomes of early surgical treatment (<24 h) and conservative treatment of incomplete cervical spinal cord injury (CSCI) without major fracture or dislocation in patients with pre-existing cervical spinal canal stenosis (CSCS). SUMMARY OF BACKGROUND DATA The relative benefits of surgery, especially early surgical treatment, and conservative treatment for CSCI without major fracture or dislocation in patients with pre-existing CSCS remain unclear. Animal models of CSCI have demonstrated that early surgical decompression immediately after the initial insult may prevent or reverse secondary injury. However, the clinical outcomes of early surgery for incomplete CSCI in patients with pre-existing CSCS are still unclear. MATERIALS AND METHODS The medical records and radiographic data of 54 patients admitted to our facility between 2005 and 2015 with American Spinal Injury Association (ASIA) impairment scale grade B or C and pre-existing CSCS without major fracture or dislocation were retrospectively reviewed. Thirty-three patients (mean age, 57.4±14.0 y) underwent early surgical treatment within 24 hours after initial trauma (S group), and 21 patients (mean age, 56.9±13.6 y) underwent conservative treatment (C group) performed by 2 spinal surgeons in accordance with their policies. The primary outcome was the degree of improvement in ASIA grade after 2 years. RESULTS During the 2-year follow-up period, higher percentages of patients in the S group than in the C group showed ≥1 grade (90.9% vs. 57.1%, P=0.0051) and 2 grade (30.3% vs. 9.5%) improvements in ASIA grade. Multivariate analysis showed that treatment type, specifically early surgical treatment, was the only factor significantly associated with ASIA grade improvement after 2 years (P=0.0044). CONCLUSIONS Early surgery yielded better neurological outcomes than conservative treatment in patients with incomplete CSCI without major fracture or dislocation and pre-existing CSCS. LEVEL OF EVIDENCE Level III.
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19
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Lim DJ. Intraoperative finding and management of complete spinal cord transection after thoracolumbar traumatic fracture-dislocation: A case report. Medicine (Baltimore) 2021; 100:e24096. [PMID: 33466175 PMCID: PMC7808503 DOI: 10.1097/md.0000000000024096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 12/08/2020] [Indexed: 01/05/2023] Open
Abstract
RATIONALE We report the first case of the management of spinal cord transection due to thoracolumbar fracture-dislocation in human beings. There are several case reports of cord transection, but only radiological findings have been reported; we report intraoperative findings and management. PATIENT CONCERNS A 53-year-old man presented to the hospital after falling. He had no motor power or sensation below T10 (below the umbilicus area) dermatome level. American Spinal Injury Association (ASIA) impairment scale was grade A. Magnetic resonance imaging and computed tomography demonstrated a fracture and translation of the vertebral body at the T11-T12 level and anterior displacement of T11 on T12, with complete disruption of the spinal cord. DIAGNOSIS Complete spinal cord resection due to T11-T12 fracture-dislocation. INTERVENTIONS We performed spinal fusion with pedicle screw instrumentation (T10-L1) and autobone graft and decompression and repaired the dural sac to prevent cerebrospinal fluid leakage. There was no neurological recovery either immediately or 4 years post-operation at follow-up. CONCLUSION To the best of our knowledge, this report is the first on the intraoperative finding and management of the complete transection of the spinal cord in thoracolumbar spine injury. Perfect fusion is required to facilitate rehabilitation and daily living, prevent neurogenesis, and prevent unnecessary pain such as phantom pain.
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Wood R, Durali P, Wall I. Impact of Dual Cell Co-culture and Cell-conditioned Media on Yield and Function of a Human Olfactory Cell Line for Regenerative Medicine. Bioengineering (Basel) 2020; 7:bioengineering7020037. [PMID: 32290611 PMCID: PMC7355638 DOI: 10.3390/bioengineering7020037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/05/2020] [Accepted: 04/10/2020] [Indexed: 02/06/2023] Open
Abstract
Olfactory ensheathing cells (OECs) are a promising candidate therapy for neuronal tissue repair. However, appropriate priming conditions to drive a regenerative phenotype are yet to be determined. We first assessed the effect of using a human fibroblast feeder layer and fibroblast conditioned media on primary rat olfactory mucosal cells (OMCs). We found that OMCs cultured on fibroblast feeders had greater expression of the key OEC marker p75NTR (25.1 ± 10.7 cells/mm2) compared with OMCs cultured on laminin (4.0 ± 0.8 cells/mm2, p = 0.001). However, the addition of fibroblast-conditioned media (CM) resulted in a significant increase in Thy1.1 (45.9 ± 9.0 cells/mm2 versus 12.5 ± 2.5 cells/mm2 on laminin, p = 0.006), an undesirable cell marker as it is regarded to be a marker of contaminating fibroblasts. A direct comparison between human feeders and GMP cell line Ms3T3 was then undertaken. Ms3T3 cells supported similar p75NTR levels (10.7 ± 5.3 cells/mm2) with significantly reduced Thy1.1 expression (4.8 ± 2.1 cells/mm2). Ms3T3 cells were used as feeder layers for human OECs to determine whether observations made in the rat model were conserved. Examination of the OEC phenotype (S100β expression and neurite outgrowth from NG108-15 cells) revealed that co-culture with fibroblast feeders had a negative effect on human OECs, contrary to observations of rat OECs. CM negatively affected rat and human OECs equally. When the best and worst conditions in terms of supporting S100β expression were used in NG108-15 neuron co-cultures, those with the highest S100β expression resulted in longer and more numerous neurites (22.8 ± 2.4 μm neurite length/neuron for laminin) compared with the lowest S100β expression (17.9 ± 1.1 μm for Ms3T3 feeders with CM). In conclusion, this work revealed that neither dual co-culture nor fibroblast-conditioned media support the regenerative OEC phenotype. In our case, a preliminary rat model was not predictive of human cell responses.
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Affiliation(s)
- Rachael Wood
- Department of Biochemical Engineering, University College London, Torrington Place, London WC1E 7JE, UK; (R.W.); (P.D.)
- School of Life & Health Sciences, Aston University, Aston Triangle, Birmingham B4 7ET, UK
| | - Pelin Durali
- Department of Biochemical Engineering, University College London, Torrington Place, London WC1E 7JE, UK; (R.W.); (P.D.)
| | - Ivan Wall
- Department of Biochemical Engineering, University College London, Torrington Place, London WC1E 7JE, UK; (R.W.); (P.D.)
- School of Life & Health Sciences, Aston University, Aston Triangle, Birmingham B4 7ET, UK
- Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan 31116, Korea
- Correspondence:
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Kafka J, Lukacova N, Sulla I, Maloveska M, Vikartovska Z, Cizkova D. Hypothermia in the course of acute traumatic spinal cord injury. Acta Neurobiol Exp (Wars) 2020. [DOI: 10.21307/ane-2020-016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Jang S, Kim J, Kim DW, Kim JW, Chun S, Lee HJ, Yi GR, Pang C. Carbon-Based, Ultraelastic, Hierarchically Coated Fiber Strain Sensors with Crack-Controllable Beads. ACS APPLIED MATERIALS & INTERFACES 2019; 11:15079-15087. [PMID: 30920201 DOI: 10.1021/acsami.9b03204] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Fiber-based electronics or textronics are spotlighted as a promising strategy to develop stretchable and wearable devices for conformable machine-human interface and ubiquitous healthcare systems. We have prepared a highly sensitive fiber-type strain sensor (maximum gauge factor (GF) = 863) with a broad range of strain (ε < 400%) by introducing a single active layer onto the fiber. In contrast to other metal-based fiber-type electronics, our hierarchical fiber sensors are based on coating carbon-based nanomaterials with responsive microbeads onto elastic fibers. Utilizing the formation of uniform cracks around the microbeads, the device performance was maximized by adjusting the number of microbeads in the carbon-coating layer. We overcoated the carbon-based coating layer of the elastic fiber with a protective polymeric layer and verified no effects on the GF and the range of strain. Our fiber sensors were repeatedly tested more than 5000 times, exhibiting excellent cyclic responses to on/off switching behaviors. For practical applications, the hierarchical fiber sensors were sewed into electrical fabric bands, which are integrable to a wireless transmitter to monitor waveforms of pulsations, respirations, and various postures of level of bending a spinal cord.
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Alexander H, Dowlati E, McGowan JE, Mason RB, Anaizi A. C2-C3 spinal fracture subluxation with ligamentous and vascular injury: a case report and review of management. Spinal Cord Ser Cases 2019; 5:4. [PMID: 30675388 DOI: 10.1038/s41394-019-0150-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 01/01/2019] [Accepted: 01/02/2019] [Indexed: 12/27/2022] Open
Abstract
Introduction Spinal cord injury is one of the leading causes of paralysis and permanent morbidity. High cervical spine injuries, in particular, have the potential to be fatal and debilitating due to injury to multiple components, including but not limited to, discoligamentous disruption, vascular insult and spinal cord injury. To date, no unifying algorithm exists making it challenging to guide treatment decisions. Case presentation We present the case of a 29-year-old polytrauma patient with an unstable C2-C3 fracture subluxation secondary to hyperextension and rotation injury with complete ligamentous dissociation and vertebral artery dissection after a high-velocity injury. We review the literature on injury patterns, associated complications and neurological outcomes in subaxial cervical spine injuries. Discussion Our patient's injuries had several components including fracture subluxation, ligamentous disruption, central cord syndrome, and vascular insult. The lack of a unifying algorithm to guide treatment decisions highlights the variations in pathology and subsequent limitations in generalizability of current literature. Our patient underwent an open anterior C2-C3 reduction and discectomy with fusion and plating and a subsequent C2-C4 posterior instrumented fusion. The patient regained some motor function postoperatively and through rehabilitation. Careful consideration of multiple components is crucial when treating subaxial spine injuries.
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Affiliation(s)
- Hepzibha Alexander
- 1Department of Neurosurgery, Medstar Georgetown University Hospital, 3800 Reservoir Rd., PHC 7, Washington, DC 20007 USA
| | - Ehsan Dowlati
- 1Department of Neurosurgery, Medstar Georgetown University Hospital, 3800 Reservoir Rd., PHC 7, Washington, DC 20007 USA
| | - Jason E McGowan
- 1Department of Neurosurgery, Medstar Georgetown University Hospital, 3800 Reservoir Rd., PHC 7, Washington, DC 20007 USA
| | - Robert B Mason
- 2Department of Neurosurgery, Medstar Washington Hospital Center, 110 Irving St. NW, Washington, DC 20010 USA
| | - Amjad Anaizi
- 1Department of Neurosurgery, Medstar Georgetown University Hospital, 3800 Reservoir Rd., PHC 7, Washington, DC 20007 USA
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Xie J, Deng X, Feng Y, Cao N, Zhang X, Fang F, Zhang S, Feng Y. Early intradural microsurgery improves neurological recovery of acute spinal cord injury: A study of 87 cases. JOURNAL OF NEURORESTORATOLOGY 2018. [DOI: 10.26599/jnr.2018.9040014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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25
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Liu Q, Wang X, Huang Z, Liu J, Ding J, Xu X, Kong G, Wu X, Yang Z, Zhu Q. Ketogenic diet delays spinal fusion and decreases bone mass in posterolateral lumbar spinal fusion: an in vivo rat model. Acta Neurochir (Wien) 2018; 160:1909-1916. [PMID: 29982887 DOI: 10.1007/s00701-018-3616-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 06/27/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Ketogenic diet (KD), a low-carbohydrate-and-high-fat diet, causes a metabolic state of ketogenesis and has been used to treat drug-resistance epilepsy. Our recent studies showed KD neuroprotective after spinal cord injury and causing bone loss. Effects of KD on spinal fusion were still unknown. This study was aimed to evaluate effects of KD on spinal fusion in rats. METHODS Thirty-two Sprague-Dawley rats were randomly divided into KD and standard diet (SD) groups. The KD group was fed with food of 1:4 carbohydrates to fat. All rats were subjected to L4/5 posterolateral lumbar spinal fusion. The blood ketone, and serum calcium, phosphorus, and insulin-like growth factor-1 (IGF-1) were measured, as well as the fusion rates, bone mass (BV), and bone mineral contents (BMC) of fusion sites were estimated at 4 and 8 weeks. RESULTS There was no significant difference in serum calcium or phosphorus levels between groups at 4 or 8 weeks. However, there was a significant increase of blood ketone (1.02 mmol/L vs 0.38 mmol/L at 4 weeks; 0.83 mmol/L vs 0.32 mmol/L, at 8 weeks) and decrease of serum IGF-1 (339.4 ng/mL vs 630.6 ng/mL at 4 weeks; 418.8 ng/mL vs 628.6 ng/mL, at 8 weeks) in the KD group compared with the SD group. The spinal fusion occurred less in the KD group (1/16 vs 6/16 at 4 weeks; 7/16 vs 10/16, at 8 weeks), particularly at 4 weeks after surgery. The BV and BMC were lower in the KD group than that in the SD group at 4 weeks, but not different between groups at 8 weeks. CONCLUSIONS This study demonstrated that KD delayed spinal fusion and decreased bone mass in posterolateral lumbar spinal fusion in rats.
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