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Chen G, Yu Y, Qian C, Jiang Y, Chen J. Comparison of microscopic full-laminectomy (open surgery) and microendoscopic minimally invasive hemilaminectomy for thoracic extramedullary spinal tumours. J Cardiothorac Surg 2024; 19:444. [PMID: 39003497 PMCID: PMC11245853 DOI: 10.1186/s13019-024-02969-4] [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: 12/19/2023] [Accepted: 07/02/2024] [Indexed: 07/15/2024] Open
Abstract
BACKGROUND Minimally invasive treatments for spinal cord tumours are common. The aim of this study was to compare the perioperative outcomes of patients with thoracic extramedullary spinal tumours (TEST) treated by microendoscopic minimally invasive surgery-hemilaminectomy through a homemade tubular retractor (MIS-TR) and microscopic full laminectomy (open surgery). METHODS Between February 2016 and February 2021, 51 patients with TEST were included. According to their clinical data, patients were classified into the MIS-TR group (n = 30) and the open surgery group (n = 21) and assessed. RESULTS In both groups, the mean operation time, change in perioperative ASIA score, and modified Macnab score were comparable. The average postoperative hospital stay in the MIS-TR group was substantially shorter than that in the open surgery group (p < 0.0001). The mean blood loss volume in the MIS-TR group was substantially lower than that in the open surgery group (p = 0.001). The perioperative complication rate in the MIS-TR group was considerably lower than that in the open surgery group (p < 0.0001). At the 3-month follow-up, there was no substantial difference in the Oswestry Disability Index (ODI) score improvement between the two groups. Nonetheless, at the 12-month follow-up, the average ODI in the MIS-TR group was considerably lower than that in the open surgery group (p = 0.023). The main influencing factors for complete postoperative recovery were preoperative ASIA score (OR 7.848, P = 0.002), surgical complications (OR 0.017, P = 0.008) and age (OR 0.974, P = 0.393). CONCLUSIONS MIS-TR is safer and more effective than open surgery for treating TEST, but the long-term recovery of MIS-TR is not better than that of open surgery.
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Affiliation(s)
- Gang Chen
- Department of Neurosurgery, Tongling People's Hospital, No.468, Tongling, 244099, Anhui, People's Republic of China.
| | - Yong Yu
- Department of Neurosurgery, Tongling People's Hospital, No.468, Tongling, 244099, Anhui, People's Republic of China
| | - Chengxing Qian
- Department of Neurosurgery, Tongling People's Hospital, No.468, Tongling, 244099, Anhui, People's Republic of China
| | - Yong Jiang
- Department of Neurosurgery, Tongling People's Hospital, No.468, Tongling, 244099, Anhui, People's Republic of China
| | - Jie Chen
- Department of Neurosurgery, Tongling People's Hospital, No.468, Tongling, 244099, Anhui, People's Republic of China
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Mora-Boga R, Vázquez-Muíños O, Pértega-Díaz S, Salvador-de la Barrera S, Ferreiro-Velasco ME, Rodríguez-Sotillo A, Meijide-Failde RM, Montoto-Marqués A. Evaluation of the prognostic value of extra-parenchymal changes in traumatic spinal cord injury, assessed by magnetic resonance imaging. J Spinal Cord Med 2024; 47:540-548. [PMID: 36441034 PMCID: PMC11218581 DOI: 10.1080/10790268.2022.2134627] [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: 11/29/2022] Open
Abstract
OBJECTIVES To analyze the relationship between neurological progression following traumatic spinal cord injury and Spinal Cord Compression (SCC) and Spinal Ligamentous Injury (LI) by magnetic resonance imaging. DESIGN Retrospective observational study. SETTING Spinal Cord Injury Unit (A Coruña, Spain). PARTICIPANTS Patients were admitted for traumatic spinal cord injury between January 2010 and December 2018 with a magnetic resonance imaging examination performed during the acute phase. INTERVENTION Evaluation of SCC and LI by magnetic resonance imaging. OUTCOME MEASURES Comparisons between neurological examination at admission and discharge were made, assessing ASIA Impairment Scale (AIS) grade and motor score. RESULTS Data from 296 patients were collected. A relationship between SCC and LI and complete injuries were found (P < 0.001). Improvement of the AIS grade was observed in 31.6% of patients with SCC and 31.3% with LI versus 42.7% and 37.8% of subjects without these complications, respectively. Regarding motor score, patients with SCC had lower mean values at the beginning (46.9 ± 26.8 versus 61.1 ± 29.9 in the control group, P < 0.001), as well as less improvement when assessed by the percentage of change (35.1 ± 37.5% versus 49.4 ± 38.1% in the control group, P = 0.010). Similar results were obtained in cases with LI: mean motor score at admission was 45.9 ± 26.7 versus 54.9 ± 29.4 in the control group (P = 0.014) and the percentage of change was 28.5 ± 37.1% in comparison to 46.0 ± 37.5% (P = 0.001) in the controls. CONCLUSIONS There is a relationship between SCC and LI and complete spinal cord injury. This patient population has lower possibilities of improving their AIS grade and motor score.
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Affiliation(s)
- Rubén Mora-Boga
- Unidad de Lesionados Medulares, Instituto de Investigación Biomédica de A Coruña (INIBIC). Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Olalla Vázquez-Muíños
- Unidad de Neurorradiología. Servicio de Radiología and Radiodiagnóstico. Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Sonia Pértega-Díaz
- Unidad de Estadística and Epidemiología Clínica. Spanish Clinical Research Network (SCReN). Complexo Hospitalario Universitario, A Coruña, Spain
| | - Sebastián Salvador-de la Barrera
- Unidad de Lesionados Medulares, Instituto de Investigación Biomédica de A Coruña (INIBIC). Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - María Elena Ferreiro-Velasco
- Unidad de Lesionados Medulares, Instituto de Investigación Biomédica de A Coruña (INIBIC). Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Antonio Rodríguez-Sotillo
- Unidad de Lesionados Medulares, Instituto de Investigación Biomédica de A Coruña (INIBIC). Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
- Departamento de Fisioterapia, Medicina y Ciencias Biomédicas, Universidad de A Coruña, A Coruña, Spain
| | - Rosa María Meijide-Failde
- Grupo de investigación en Terapia Celular y Medicina Regenerativa. Departamento de Fisioterapia, Medicina y Ciencias Biomédicas, Centro de Investigaciones Científicas Avanzadas (CICA), Facultad de Ciencias de la Salud, Universidade da Coruña, A Coruña, Spain
| | - Antonio Montoto-Marqués
- Unidad de Lesionados Medulares, Instituto de Investigación Biomédica de A Coruña (INIBIC). Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
- Departamento de Fisioterapia, Medicina y Ciencias Biomédicas, Universidad de A Coruña, A Coruña, Spain
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Chu X, Liu S, Zhao X, Liu T, Xing Z, Li Q, Li Q. Case report: Virtual reality-based arm and leg cycling combined with transcutaneous electrical spinal cord stimulation for early treatment of a cervical spinal cord injured patient. Front Neurosci 2024; 18:1380467. [PMID: 38826775 PMCID: PMC11140104 DOI: 10.3389/fnins.2024.1380467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 05/06/2024] [Indexed: 06/04/2024] Open
Abstract
Spinal cord injury is a condition affecting the central nervous system, causing different levels of dysfunction below the point of nerve damage. A 50-year-old woman suffered a neck injury as a result of a car accident. After undergoing posterior cervical C3-C6 internal fixation with titanium plates on one side and C7 lamina decompression, the patient, who had been diagnosed with C3-C7 cervical disk herniation and spinal stenosis causing persistent compression of the spinal cord, was transferred to the rehabilitation department. After implementing the combined therapy of Virtual Reality-based arm and leg cycling along with transcutaneous electrical stimulation of the spinal cord, the patients experienced a notable enhancement in both sensory and motor abilities as per the ASIA scores. The patient's anxiety and depression were reduced as measured by the Hamilton Anxiety and Hamilton Depression Tests. As evaluated by the SCIM-III, the patient's self-reliance and capacity to carry out everyday tasks showed ongoing enhancement, leading to the restoration of their functionality. Hence, the use of Virtual Reality-based arm and leg cycling along with transcutaneous electrical spinal cord stimulation has potential to positively impact function in patients with spinal cord injury. However, as this is a case report, the small number of patients and the fact that the intervention was initiated early after the injury, we were unable to separate the recovery due to the intervention from the natural recovery that is known to occur in the initial weeks and months after SCI. Therefore, further randomized controlled trials with a large sample size is necessary.
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Affiliation(s)
- Xiaolei Chu
- Department of Rehabilitation, Tianjin University Tianjin Hospital, Tianjin, China
| | - Shuaiyi Liu
- Tianjin Key Laboratory of Exercise Physiology and Sports Medicine, Institute of Sport, Exercise and Health, Tianjin University of Sport, Tianjin, China
| | - Xiaoxuan Zhao
- Tianjin Key Laboratory of Exercise Physiology and Sports Medicine, Institute of Sport, Exercise and Health, Tianjin University of Sport, Tianjin, China
| | - Tao Liu
- Tianjin Key Laboratory of Exercise Physiology and Sports Medicine, Institute of Sport, Exercise and Health, Tianjin University of Sport, Tianjin, China
| | - Zheng Xing
- Department of Rehabilitation, Tianjin University Tianjin Hospital, Tianjin, China
| | - Qingwen Li
- Tianjin Key Laboratory of Exercise Physiology and Sports Medicine, Institute of Sport, Exercise and Health, Tianjin University of Sport, Tianjin, China
| | - Qi Li
- Department of Rehabilitation, Tianjin University Tianjin Hospital, Tianjin, China
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Basiratzadeh S, Hakimjavadi R, Baddour N, Michalowski W, Viktor H, Wai E, Stratton A, Kingwell S, Mac-Thiong JM, Tsai EC, Wang Z, Phan P. A data-driven approach to categorize patients with traumatic spinal cord injury: cluster analysis of a multicentre database. Front Neurol 2023; 14:1263291. [PMID: 37900603 PMCID: PMC10602788 DOI: 10.3389/fneur.2023.1263291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/05/2023] [Indexed: 10/31/2023] Open
Abstract
Background Conducting clinical trials for traumatic spinal cord injury (tSCI) presents challenges due to patient heterogeneity. Identifying clinically similar subgroups using patient demographics and baseline injury characteristics could lead to better patient-centered care and integrated care delivery. Purpose We sought to (1) apply an unsupervised machine learning approach of cluster analysis to identify subgroups of tSCI patients using patient demographics and injury characteristics at baseline, (2) to find clinical similarity within subgroups using etiological variables and outcome variables, and (3) to create multi-dimensional labels for categorizing patients. Study design Retrospective analysis using prospectively collected data from a large national multicenter SCI registry. Methods A method of spectral clustering was used to identify patient subgroups based on the following baseline variables collected since admission until rehabilitation: location of the injury, severity of the injury, Functional Independence Measure (FIM) motor, and demographic data (age, and body mass index). The FIM motor score, the FIM motor score change, and the total length of stay were assessed on the subgroups as outcome variables at discharge to establish the clinical similarity of the patients within derived subgroups. Furthermore, we discussed the relevance of the identified subgroups based on the etiological variables (energy and mechanism of injury) and compared them with the literature. Our study also employed a qualitative approach to systematically describe the identified subgroups, crafting multi-dimensional labels to highlight distinguishing factors and patient-focused insights. Results Data on 334 tSCI patients from the Rick Hansen Spinal Cord Injury Registry was analyzed. Five significantly different subgroups were identified (p-value ≤0.05) based on baseline variables. Outcome variables at discharge superimposed on these subgroups had statistically different values between them (p-value ≤0.05) and supported the notion of clinical similarity of patients within each subgroup. Conclusion Utilizing cluster analysis, we identified five clinically similar subgroups of tSCI patients at baseline, yielding statistically significant inter-group differences in clinical outcomes. These subgroups offer a novel, data-driven categorization of tSCI patients which aligns with their demographics and injury characteristics. As it also correlates with traditional tSCI classifications, this categorization could lead to improved personalized patient-centered care.
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Affiliation(s)
| | | | - Natalie Baddour
- Department of Mechanical Engineering, Faculty of Engineering, University of Ottawa, Ottawa, ON, Canada
| | | | - Herna Viktor
- School of Electrical Engineering and Computer Science, Faculty of Engineering, University of Ottawa, Ottawa, ON, Canada
| | - Eugene Wai
- Division of Orthopedic Surgery, Ottawa Hospital Research Institute (OHRI), Ottawa, ON, Canada
- Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Alexandra Stratton
- Division of Orthopedic Surgery, Ottawa Hospital Research Institute (OHRI), Ottawa, ON, Canada
- Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Stephen Kingwell
- Division of Orthopedic Surgery, Ottawa Hospital Research Institute (OHRI), Ottawa, ON, Canada
- Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jean-Marc Mac-Thiong
- Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Eve C. Tsai
- Division of Neurosurgery, The Ottawa Hospital, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Zhi Wang
- Department of Orthopedic Surgery, University of Montreal Health Center, Montreal, QC, Canada
| | - Philippe Phan
- Division of Orthopedic Surgery, Ottawa Hospital Research Institute (OHRI), Ottawa, ON, Canada
- Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Masse‐Gignac N, Flórez‐Jiménez S, Mac‐Thiong J, Duong L. Attention-gated U-Net networks for simultaneous axial/sagittal planes segmentation of injured spinal cords. J Appl Clin Med Phys 2023; 24:e14123. [PMID: 37735825 PMCID: PMC10562020 DOI: 10.1002/acm2.14123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 09/23/2023] Open
Abstract
Magnetic resonance imaging is currently the gold standard for the evaluation of spinal cord injuries. Automatic analysis of these injuries is however challenging, as MRI resolutions vary for different planes of analysis and physiological features are often distorted around these injuries. This study proposes a new CNN-based segmentation method in which information is exchanged between two networks analyzing the scans from different planes. Our aim was to develop a robust method for automatic segmentation of the spinal cord in patients having suffered traumatic injuries. The database consisted of 106 sagittal MRI scans from 94 patients with traumatic spinal cord injuries. Our method used an innovative approach where the scans were analyzed in series under the axial and sagittal plane by two different convolutional networks. The results were compared with those of Deepseg 2D from the Spinal Cord Toolbox (SCT), which was taken as state-of-the-art. Comparisons were evaluated using K-Fold cross-validation combined with statistical t-test results on separate test data. Our method achieved significantly better results than Deepseg 2D, with an average Dice coefficient of 0.95 against 0.88 for Deepseg 2D (p <0.001). Other metrics were also used to compare the segmentations, all of which showed significantly better results for our approach. In this study, we introduce a robust method for spinal cord segmentation which is capable of adequately segmenting spinal cords affected by traumatic injuries, improving upon the methods contained in SCT.
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Affiliation(s)
- Nicolas Masse‐Gignac
- Department of software and IT engineeringÉcole de technologie supérieureMontréalCanada
- Department of orthopedic surgeryHopital Sacré‐CoeurMontréalCanada
| | - Salomón Flórez‐Jiménez
- Department of software and IT engineeringÉcole de technologie supérieureMontréalCanada
- Department of orthopedic surgeryHopital Sacré‐CoeurMontréalCanada
| | - Jean‐Marc Mac‐Thiong
- Department of software and IT engineeringÉcole de technologie supérieureMontréalCanada
- Department of orthopedic surgeryHopital Sacré‐CoeurMontréalCanada
| | - Luc Duong
- Department of software and IT engineeringÉcole de technologie supérieureMontréalCanada
- Department of orthopedic surgeryHopital Sacré‐CoeurMontréalCanada
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Clark JM, Bednarz JM, Batchelor PE, Skeers P, Freeman BJC. Prehospital Cardiovascular Autoregulatory Disturbances Correlate With the Functional Neuroanatomy of Acute Spinal Cord Injury. Spine (Phila Pa 1976) 2023; 48:428-435. [PMID: 36577080 DOI: 10.1097/brs.0000000000004571] [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: 07/13/2022] [Accepted: 09/19/2022] [Indexed: 12/30/2022]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE The importance of attenuating the cardiovascular autoregulatory disturbances accompanying acute spinal cord injury (SCI) has long been recognized. This report assembles SCI emergency service data and correlates cardiovascular parameters to preserved functional neuroanatomy. SUMMARY OF BACKGROUND DATA The nascent nature of evidence-based reporting of prehospital cardiovascular autoregulatory disturbances in SCI indicates the need to assemble more information. MATERIALS AND METHODS SCI data for <24 hours were extracted from ambulance and hospital records. The mean arterial pressure (MAP) was calculated. The International Standard for Neurological Classification of SCI (ISNCSCI) evaluates the primary outcome of motor incomplete injury (grades C/D) at acute presentation. Logistic regression was adjusted for multiple confounders that were expected to influence the odds of grade C/D. RESULTS A cohort of 99 acute SCI cases was retained; mean (SD) age 40.7±20.5 years, 88 male, 84 tetraplegic, 65 grades A/B (motor complete injury), triage time 2±1.6 hours. The lowest recorded prehospital MAP [mean (SD): 77.9±19, range: 45-145 mm Hg] approached the nadir for adequate organ perfusion. Thirty-four (52%) grade A/B and 10 (30%) C/D cases had MAP readings <85 mm Hg. In data adjusted for age, injury level, and triage time a 5 mm Hg increase in the lowest MAP value was associated with a 34% increase in the odds of having motor incomplete injury at acute presentation (adjusted odds ratio=1.34; 95% CI: 1.11-1.61; P =0.002). CONCLUSION An important observation with implications for timely and selective cardiovascular resuscitation during SCI prehospital care involves significant negative associations between the depth of systemic hypotension and preserved functional neuroanatomy. Regardless of the mechanism, our confounder-adjusted logistic regression model extends in-hospital evidence and provides a conceptual bedside-bench framework for future investigations.
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Affiliation(s)
- Jillian M Clark
- Centre for Orthopaedics and Trauma Research, School of Medicine
| | - Jana M Bednarz
- Data, Design and Statistics Service, Adelaide Health Technology Assessment, School of Public Health
| | - Peter E Batchelor
- Department of Neurology, University Hospital Geelong, Geelong, Victoria
| | - Peta Skeers
- NHMRC Clinical Trial Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Brian J C Freeman
- Royal Adelaide Hospital, Centre for Orthopaedic and Trauma Research, University of Adelaide, Adelaide, South Australia
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Sharwood LN, King V, Ball J, Varma D, Stanford RW, Middleton JW. The influence of initial spinal cord haematoma and cord compression on neurological grade improvement in acute traumatic spinal cord injury: A prospective observational study. J Neurol Sci 2022; 443:120453. [PMID: 36308844 DOI: 10.1016/j.jns.2022.120453] [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: 05/02/2022] [Revised: 09/26/2022] [Accepted: 10/04/2022] [Indexed: 11/21/2022]
Abstract
STUDY DESIGN Prospective observational cohort study linked with administrative data. OBJECTIVES Magnetic Resonance Imaging (MRI) is routinely performed after traumatic spinal cord injury (TSCI), facilitating early, accurate diagnosis to optimize clinical management. Prognosis from early MRI post-injury remains unclear, yet if available could guide early intervention. The aim of this study was to determine the association of spinal cord intramedullary haematoma and/or extent of cord compression evident on initial spine MRI with neurological grade change after TSCI. METHODS Individuals with acute TSCI ≥16 years of age; MRI review. Neurological gradings (American Spinal Injury Association Impairment Scale (AIS)) were compared with initial MRI findings. Various MRI parameters were evaluated for prediction of neurological improvement pre-discharge. RESULTS 120 subjects; 79% male, mean (SD) age 51.0 (17.7) years. Motor vehicle crashes (42.5%) and falls (40.0%) were the most common injury mechanisms. Intramedullary spinal cord haematoma was identified by MRI in 40.0% of patients and was associated with more severe neurologic injury (58.3% initially AIS A). Generalised linear regression showed higher maximum spinal cord compression (MSCC) was associated with lower likelihood of neurological improvement from initial assessment to follow up prior to rehabilitation discharge. Combined thoracic level injury, intramedullary haematoma, and MSCC > 25% resulted in almost 90% probability of pre-discharge AIS (grade A) remaining unchanged from admission assessment. CONCLUSIONS MRI is a vital tool for evaluating the severity and extent of TSCI, assisting in appropriate management decision-making early in TSCI patient care. This study adds to the body of knowledge assisting clinicians in prognostication.
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Affiliation(s)
- L N Sharwood
- University of Sydney, Sydney Medical School, Northern, C/o Kolling Institute, 1 Reserve Road, St Leonards, NSW 2065, Australia; Faculty of Medicine and Health, University of New South Wales, Australia.
| | - V King
- Royal North Shore Hospital, Department of Neurosurgery, Australia
| | - J Ball
- Royal North Shore Hospital, Department of Neurosurgery, Australia.
| | - D Varma
- Radiology, Emergency & Trauma Radiology, The Alfred Health & Monash University, National Trauma Research Institute, Australia; Mission TBI, MRFF Aus Govt., Australia.
| | - R W Stanford
- Prince of Wales Hospital, Department of Orthopedics, Australia
| | - J W Middleton
- Rehabilitation Medicine, University of Sydney, Sydney Medical School, Northern Faculty of Medicine and Health, Australia.
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Predictive Factors for Late-Onset Neurological Deficits in Patients with Posttuberculous Thoracic Kyphosis. BIOMED RESEARCH INTERNATIONAL 2022; 2022:8555924. [PMID: 36119921 PMCID: PMC9473887 DOI: 10.1155/2022/8555924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/22/2022] [Accepted: 07/23/2022] [Indexed: 11/21/2022]
Abstract
Background Patients with severe posttuberculous (TB) kyphosis might suffer from late-onset neurological deficits, and surgical correction may improve neurological function. However, there is a lack of predictive factors for neurological function in these patients. Objective This study was aimed at identifying the risk factors for late-onset neurological deficits in spinal TB patients at initial and final assessments. Methods Seventy-eight patients with severe kyphosis caused by old thoracic tuberculosis were retrospectively analyzed. Patients with active spinal TB and other spinal diseases were excluded from the analysis. The kyphosis Cobb angle, sagittal deformity angular ratio (S-DAR), and level of apex were measured and calculated on X-ray. The spinal cord cross-sectional area ratio (CSAR), spinal cord sagittal diameter ratio (SDR), and spinal cord angle (SCA) were measured on preoperative T2-weighted magnetic resonance imaging (MRI). According to the American Spinal Injury Association (ASIA) Impairment Scale (AIS) at the time of admission, the patients were divided into the symptomatic group (N = 60 patients, AIS grades A to D) and the asymptomatic group (N = 18 patients, AIS grade E). All of the symptomatic patients underwent surgery, and the patients from both groups had at least 2 years of follow-up. Relationships among the radiological parameters and initial and final AIS grades were evaluated via univariate and multivariate analyses. Results The mean duration of kyphotic deformity was 37.4 years in the symptomatic group. There were no significant differences between the two groups in terms of CSAR, kyphosis Cobb angle, S-DAR, level of apex, or the segments that were involved. Patients from the symptomatic group exhibited significantly greater SDR and smaller SCA than those from the asymptomatic group (p < 0.01 and p < 0.01, respectively). The multivariate logistic regression identified SDR and SCA as independent factors influencing the likelihood of spinal cord injury at the initial and final assessments. Conclusions Severe posttuberculous kyphosis may lead to significant neurological symptoms many years following the initial treatment. The predictive factors for late-onset neurological deficits include larger SDR and smaller SCA.
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Gao X, Gong Y, Zhang B, Hao D, He B, Yan L. Factors for Predicting Instant Neurological Recovery of Patients with Motor Complete Traumatic Spinal Cord Injury. J Clin Med 2022; 11:jcm11144086. [PMID: 35887845 PMCID: PMC9319428 DOI: 10.3390/jcm11144086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/30/2022] [Accepted: 07/12/2022] [Indexed: 02/04/2023] Open
Abstract
The objective of this study was to analyze the factors affecting the instant recovery of neurological function in patients with motor complete traumatic spinal cord injury (TSCI) treated in hospital. Methods: A retrospective analysis of 1053 patients with TSCI classified according to the American Spinal Cord Injury Association (ASIA) as grades A and B at 59 tertiary hospitals from 1 January 2018 to 31 December 2018 was performed. All patients were classified into motor complete injury (ASIA A or B) and motor incomplete injury (ASIA C or D) groups, according to the ASIA upon discharge. The injury level, fracture segment, fracture type, ASIA score at admission and discharge, treatment protocol, and complications were recorded. Univariate and multivariate analyses were performed to evaluate the relationship between various factors and the recovery of neurological function. Results: The results of multiple logistic regression analysis revealed that the ASIA score on admission (p < 0.001, odds ratio (OR) = 5.722, 95% confidence interval (CI): 4.147−7.895), fracture or dislocation (p = 0.001, OR = 0.523, 95% CI: 0.357−0.767), treatment protocol (p < 0.001; OR = 2.664, 95% CI: 1.689−4.203), and inpatient rehabilitation (p < 0.001, OR = 2.089, 95% CI: 1.501−2.909) were independently associated with the recovery of neurological function. Conclusion: The recovery of neurological function is dependent on the ASIA score on admission, fracture or dislocation, treatment protocol, and inpatient rehabilitation.
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Affiliation(s)
- Xiangcheng Gao
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an 710054, China; (X.G.); (Y.G.); (B.Z.); (D.H.); (B.H.)
- Medical College, Yan’an University, Yan’an 716000, China
| | - Yining Gong
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an 710054, China; (X.G.); (Y.G.); (B.Z.); (D.H.); (B.H.)
| | - Bo Zhang
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an 710054, China; (X.G.); (Y.G.); (B.Z.); (D.H.); (B.H.)
- Medical College, Yan’an University, Yan’an 716000, China
| | - Dingjun Hao
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an 710054, China; (X.G.); (Y.G.); (B.Z.); (D.H.); (B.H.)
| | - Baorong He
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an 710054, China; (X.G.); (Y.G.); (B.Z.); (D.H.); (B.H.)
| | - Liang Yan
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an 710054, China; (X.G.); (Y.G.); (B.Z.); (D.H.); (B.H.)
- Correspondence:
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Xu M, Tan GY, Tao XM. Research on Differentiation of Bone Marrow Stromal Cells (BMSCs) Prompted by MicroRNA-124 and Effect on Inflammatory Reaction of Spinal Cord Injury Nerve Cells. J BIOMATER TISS ENG 2022. [DOI: 10.1166/jbt.2022.2921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The major feature of spinal cord injury (SCI) was the damage of nervous tissue in spinal cord. The damaged spinal cord was difficult to be repaired and regenerated. MicroRNA-124 could play a role in the repairing and recovering the injured tissue. The BMSCs could participate in repairing
the damage. However, the regulatory effect of MicroRNA-124 on BMSCs and the inflammatory response of SCI was still not illustrated. These spinal cord nerve cells were assigned into group of mechanical damage, BMSCs and BMSCs with miR-124 overexpression followed by analysis of proliferation
of nerve cells by MTT assay, apoptotic activity, expression of miR-124, GFAP and BDNF by Real time PCR, levels of TNF-α and IL-6 by ELISA as well as MDH and SOD activity. miR-124 mimics transfection significantly promoted BMSCs proliferation and increased ALK activity and the
expression of GFAP and BDNF. In conclusion, the proliferation and differentiation of BMSCs could be regulated by miR-124. The inflammation and oxidative stress could be restrained so as to prompt the proliferation and repair of SCI cells and restrain apoptosis, indicating that it might be
beneficial to recover the SCI.
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Affiliation(s)
- Ming Xu
- Department of Neurology, The People’s Hospital of Dazu District, First Affiliated Hospital of Chongqing Medical University, Chongqing, 402360, China
| | - Guo Yong Tan
- Department of Neurology, The People’s Hospital of Dazu District, First Affiliated Hospital of Chongqing Medical University,Chongqing, 402360, China
| | - Xian Ming Tao
- Department of Neurology, The People’s Hospital of Dazu District, First Affiliated Hospital of Chongqing Medical University,Chongqing, 402360, China
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Dodd W, Motwani K, Small C, Pierre K, Patel D, Malnik S, Lucke-Wold B, Porche K. Spinal cord injury and neurogenic lower urinary tract dysfunction: what do we know and where are we going? JOURNAL OF MEN'S HEALTH 2022; 18:24. [PMID: 35106100 PMCID: PMC8803268 DOI: 10.31083/j.jomh1801024] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
One of the well reported but difficult to manage symptoms of spinal cord injury (SCI) is neurogenic lower urinary tract dysfunction (NLUTD). The type of NLUTD is variable based on location and extent of injury. SCI affects more males and NLUTD is especially debilitating for men with incomplete injury. This review summarizes the anatomical basis of NLUTD in SCI and discusses current diagnostic and management strategies that are being utilized clinically. The last two sections address new innovations and emerging discoveries with the goal of increasing scientific interest in improving treatment options for people with SCI. Areas warranting further investigation are pinpointed to address current gaps in knowledge and/or appropriate technology.
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Affiliation(s)
- William Dodd
- Department of Neurosurgery, University of Florida,
Gainesville, FL 32601, USA
| | - Kartik Motwani
- Department of Neurosurgery, University of Florida,
Gainesville, FL 32601, USA
| | - Coulter Small
- Department of Neurosurgery, University of Florida,
Gainesville, FL 32601, USA
| | - Kevin Pierre
- Department of Neurosurgery, University of Florida,
Gainesville, FL 32601, USA
| | - Devan Patel
- Department of Neurosurgery, University of Florida,
Gainesville, FL 32601, USA
| | - Samuel Malnik
- Department of Neurosurgery, University of Florida,
Gainesville, FL 32601, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida,
Gainesville, FL 32601, USA
| | - Ken Porche
- Department of Neurosurgery, University of Florida,
Gainesville, FL 32601, USA
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Chen H, Cao J, Zhang S, Sui T, Yang K, Cao X. Application of Extradural Nerve Root Transfer in the Restoration of Lower Limb Function in Spinal Cord Injury: Hypothesis and a Cadaver Feasibility Study. Spine (Phila Pa 1976) 2021; 46:1363-1369. [PMID: 34559748 DOI: 10.1097/brs.0000000000004013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Two fresh-frozen and six formalin-fixed cadavers were included in the study. OBJECTIVE To ascertain whether transferring T9 or T11 ventral root (VR) to L2 VR and T10 or T12 VR to L3 VR in restoring lower limb function after spinal cord injury is anatomically feasible. SUMMARY OF BACKGROUND DATA Lower limb paralysis impairs the quality of the life and places burden on the whole society. However, no significant improvement in this area was achieved during recent years. METHODS In the present study, two fresh-frozen and six formalin-fixed cadavers were dissected to confirm the anatomical feasibility. A limited laminectomy was performed to expose the T9-L3 extradural nerve roots. T9 and T10 VR were anastomosed to L2 and L3 VR respectively, or T11 and T12 VR were anastomosed to L2 and L3 VR respectively. The pertinent distances between the donor and recipient nerves were measured and H&E staining was used to detect the axon number and cross-section area of each VR. RESULTS The limited incision was performed to expose the T9-L3 nerve root. According to the anatomic landmark of dorsal root ganglion, each VR could be isolated from each extradural nerve root. The T9 or T11 VR needs sural nerve graft to be transferred to L2 VR, and T10 or T12 VR also needs a nerve bridge to connect to L3 VR. The nerve numbers of T9, T10, T11, T12, L2, and L3 VRs and the sural nerves were measured respectively. The cross-section areas of T9, T10, T11, T12, L2, and L3 VRs and sural nerves were measured respectively. CONCLUSION Our study suggested that application of transferring T9 or T11 VR to L2 VR and T10 or T12 VR to L3 VR in restoring lower limb function is anatomically feasible.Level of Evidence: 5.
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Affiliation(s)
- Hongtao Chen
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jiang Cao
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Sheng Zhang
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Tao Sui
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Kaixiang Yang
- Department of Orthopedics, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaojian Cao
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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Huang W, Cao Z, Wu Y, Li Z, Li L, Zhao Y. Bone Marrow Mesenchymal Stem Cells (BMSCs) Promote Neuronal Cell Repair in Spinal Cord Injury by Regulating Toll-Like Receptor 4/Nuclear Factor-Kappa B Signaling Pathway. J BIOMATER TISS ENG 2021. [DOI: 10.1166/jbt.2021.2791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SCI (SCI) poses a challenge to nerve cell repair strategies. SCI injury can lead to the development of inflammation, which in turn can exacerbate nerve cell damage. The TLR4/NF-kappa B signaling pathway is a common inflammatory signaling pathway. Since BMSCs are involved in injury repair,
whether they can promote the repair of SCI neuronal cells have not been reported. Spinal cord nerve cells were cultured in vitro and divided into mechanical injury group and BMSCs group followed by analysis of cell proliferation activity and detection of altered apoptotic activity.
Changes in the concentrations of IL-6 and IL-1β were measured by ELISA and cellular mitochondrial alterations was assessed by JG-B staining along with analysis of NF-kappa B, TLR4, related neurodevelopmental factor BDNF, and NGF expression by western blot. Mechanical damage to
neuronal cells resulted in decreased cell proliferation, increased apoptotic activity, decreased cellular mitochondrial activity, increased TLR4 and NF-kappa B expression, decreased BDNF and NGF expression, as well as increased secertions of IL-6 and IL-1β (P < 0.05).
In contrast, co-culture with BMSCs resulted in increased proliferation and decreased apoptosis of mechanically injured neuronal cells, increased cellular mitochondrial activity, with observation of the inverse changes in other factors (P < 0.05). In conclusion, BMSCs can suppress
inflammation and promote repair of injured neuronal cells by inhibiting TLR4/NF-kappa B signaling.
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Affiliation(s)
- Wei Huang
- Department of Orthopedics, Fourth Medical Center of the General Hospital of CPLA, Beijing, 100048, China
| | - Zheng Cao
- Department of Orthopedics, Fourth Medical Center of the General Hospital of CPLA, Beijing, 100048, China
| | - Ye Wu
- Department of Orthopedics, Fourth Medical Center of the General Hospital of CPLA, Beijing, 100048, China
| | - Zhenzhou Li
- Department of Orthopedics, Fourth Medical Center of the General Hospital of CPLA, Beijing, 100048, China
| | - Li Li
- Department of Orthopedics, Fourth Medical Center of the General Hospital of CPLA, Beijing, 100048, China
| | - Yantao Zhao
- Department of Orthopedics, Fourth Medical Center of the General Hospital of CPLA, Beijing, 100048, China
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Traumatic cervical spinal cord injury: relationship of MRI findings to initial neurological impairment. 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 2021; 30:3666-3675. [PMID: 34545441 DOI: 10.1007/s00586-021-06996-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/30/2021] [Accepted: 09/14/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To quantify the degree of available space for the cord and cord swelling in patients following traumatic cervical spinal cord injury (TCSCI), and to assess the relationship among the available space for the cord, cord swelling, and the severity of neurological impairment. METHODS This study included 91 patients. The following indexes were measured by two blinded observers: maximum cord available area (CAAmax) and maximum cord swelling area (CSAmax). The American Spinal Injury Association (ASIA) impairment scale (AIS) grades were used to evaluate the extent of neurological injury. Relationship among CAAmax, CSAmax, and initial AIS grades was assessed via univariate and multivariate analyses. RESULTS Patients who were AIS grade A (complete injury) demonstrated significantly greater median CAAmax and CSAmax than AIS grade C or D (incomplete injury) (P < 0.01). Multivariate analysis identified only CAAmax (OR 20.88 [95% CI 1.50-291.21]; P = 0.024) and CSAmax (OR 17.84 [95% CI 1.15-276.56]; P = 0.039) were identified as independently influencing the likelihood of complete injury at the initial assessment. The classification accuracy was best for CAAmax and CSAmax; areas under the curve were 0.8998 (95% CI 0.7881-1.0000) and 0.9167 (95% CI 0.8293-1.0000), respectively. CONCLUSION The present study provides a novel radiologic method for identifying the severity of TCSCI with T2-weighted MRI findings. Greater available space for the cord (CAAmax > 38%) and cord swelling (CSAmax > 29%) can be used to identify patients at risk for TCSCI and both imaging characteristics are associated with an increased likelihood of severe neurological deficits. LEVEL OF EVIDENCE Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.
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Wang J, Kong X, Li Q, Li C, Yu H, Ning G, Xiang Z, Liu Y, Feng S. The spatial arrangement of cells in a 3D-printed biomimetic spinal cord promotes directional differentiation and repairs the motor function after spinal cord injury. Biofabrication 2021; 13. [PMID: 34139682 DOI: 10.1088/1758-5090/ac0c5f] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 06/17/2021] [Indexed: 12/25/2022]
Abstract
Spinal cord injury is a permanent destructive disease that causes devastating neurologic deficits and disability. Long-term complications are associated with low prognosis, mortality, and decreased quality of life. The functional recovery depends on the regeneration of neurons and the growth of medullated axons. Single treatment strategies, including cell transplantation, cannot adapt to a changeable microenvironment. Patients with spinal cord injuries need more effective, long-term, and stable treatment options. Therefore, we investigated the benefit of a combined-tissue engineering strategy by loading homologous bone mesenchymal stem cells (BMSCs) and Schwann cells in three-dimensional (3D) scaffolds. We placed BMSCs and Rat Schwann cells (RSCs) in specific spatial arrangements using cell gravity and the diffusion effect to promote the formation of intercellular connections and cell-directed differentiation. This novel bioengineering system allowed us to control multiple factors, including cell types, cell relative position, and axon growth direction in the scaffold. Our system facilitated motor function recovery by enhancing tissue mimicry and allowing the reconstruction of medullated axons. This new 3D-integrated printing platform is multi-function and can simulate biomimetic tissue using different types of materials and multi-cells scaffolds. We believe that this study can help promote the clinical development and application of 3D printing in the field of regenerative medicine.
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Affiliation(s)
- Jianhao Wang
- International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord Injury, Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin 300052, People's Republic of China
| | - Xiaohong Kong
- School of Medicine Nankai University, Tianjin 300071, People's Republic of China
| | - Qian Li
- Department of Anesthesiology Tianjin Central Hospital of Gynecology Obstetrics, Tianjin 300052, People's Republic of China
| | - Chao Li
- International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord Injury, Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin 300052, People's Republic of China
| | - Hao Yu
- International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord Injury, Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin 300052, People's Republic of China
| | - Guangzhi Ning
- International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord Injury, Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin 300052, People's Republic of China
| | - Ziqian Xiang
- International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord Injury, Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin 300052, People's Republic of China
| | - Yang Liu
- International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord Injury, Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin 300052, People's Republic of China
| | - Shiqing Feng
- International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord Injury, Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin 300052, People's Republic of China
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Early Predictors of Neurological Outcomes After Traumatic Spinal Cord Injury: A Systematic Review and Proposal of a Conceptual Framework. Am J Phys Med Rehabil 2021; 100:700-711. [PMID: 34131094 DOI: 10.1097/phm.0000000000001701] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Neurological outcomes after traumatic spinal cord injury are variable and depend on patient-, trauma-, and treatment-related factors as well as on spinal cord injury characteristics, imaging, and biomarkers. OBJECTIVE The aims of the study were to identify and classify the early predictors of neurological outcomes after traumatic spinal cord injury. DATA SOURCES The Medline, PubMed, Embase, and the Cochrane Central Database were searched using medical subject headings. The search was extended to the reference lists of identified studies. STUDY ELIGIBILITY CRITERIA The study eligibility criteria were assessment of neurological outcomes as primary or secondary outcome, predictors collected during the acute phase after traumatic spinal cord injury, and multivariate design. PARTICIPANTS The participants were adult patients with traumatic spinal cord injury followed at least 3 mos after injury. STUDY APPRAISAL AND SYNTHESIS METHODS The quality of studies was assessed by two independent reviewers using the Study Quality Assessment Tools for Observational Cohort and Cross-sectional Studies. The studies' narrative synthesis relied on a classification of the predictors according to quantity, quality, and consistency of the evidence. Results were summarized in a conceptual framework. RESULTS Forty-nine articles were included. The initial severity of traumatic spinal cord injury (American Spinal Injury Association Impairment Scale, motor score, and neurological level of injury) was the strongest predictor of neurological outcomes: patients with more severe injury at admission presented poor neurological outcomes. Intramedullary magnetic resonance imaging signal abnormalities were also associated with neurological outcomes, as the presence of intramedullary hemorrhage was a factor of poor prognosis. Other largely studied predictors, such as age and surgical timing, showed some inconsistency in results depending on cutoffs. Younger age and early surgery were generally associated with good outcomes. Although widely studied, other factors, such as vertebral and associated injuries, failed to show association with outcomes. Cerebrospinal fluid inflammatory biomarkers, as emerging factors, were significantly associated with outcomes. CONCLUSIONS This study provides a comprehensive review of predictors of neurological outcomes after traumatic spinal cord injury. It also highlights the heterogeneity of outcomes used by studies to assess neurological recovery. The proposed conceptual framework classifies predictors and illustrates their relationships with outcomes.
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Schading S, Emmenegger TM, Freund P. Improving Diagnostic Workup Following Traumatic Spinal Cord Injury: Advances in Biomarkers. Curr Neurol Neurosci Rep 2021; 21:49. [PMID: 34268621 PMCID: PMC8282571 DOI: 10.1007/s11910-021-01134-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Traumatic spinal cord injury (SCI) is a life-changing event with drastic implications for patients due to sensorimotor impairment and autonomous dysfunction. Current clinical evaluations focus on the assessment of injury level and severity using standardized neurological examinations. However, they fail to predict individual trajectories of recovery, which highlights the need for the development of advanced diagnostics. This narrative review identifies recent advances in the search of clinically relevant biomarkers in the field of SCI. RECENT FINDINGS Advanced neuroimaging and molecular biomarkers sensitive to the disease processes initiated by the SCI have been identified. These biomarkers range from advanced neuroimaging techniques, neurophysiological readouts, and molecular biomarkers identifying the concentrations of several proteins in blood and CSF samples. Some of these biomarkers improve current prediction models based on clinical readouts. Validation with larger patient cohorts is warranted. Several biomarkers have been identified-ranging from imaging to molecular markers-that could serve as advanced diagnostic and hence supplement current clinical assessments.
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Affiliation(s)
- Simon Schading
- Spinal Cord Injury Centre, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Tim M Emmenegger
- Spinal Cord Injury Centre, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Patrick Freund
- Spinal Cord Injury Centre, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
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Zhao L, Shen J, Jia K, Shi F, Hao Q, Gao F. MicroRNA-24-3p Inhibits Microglia Inflammation by Regulating MK2 Following Spinal Cord Injury. Neurochem Res 2021; 46:843-852. [PMID: 33439430 DOI: 10.1007/s11064-020-03211-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 06/30/2020] [Accepted: 12/18/2020] [Indexed: 11/27/2022]
Abstract
Spinal cord injury (SCI) is a functional impairment of the spinal cord caused by external forces, accompanied by limb movement disorders and permanent paralysis, which seriously lowers the life quality of SCI patients. Secondary injury caused by inflammation attenuated the therapeutic effects of SCI. Therefore, the exploration of biomarkers associated with the inflammatory response following SCI might provide novel therapy strategy against SCI.SCI rat model was established as previously reported and evaluated by BBB score. The expression of microRNA-24-3p (miR-24-3p) and MAPK-activated protein kinase 2 (MK2) in spinal cord tissues of SCI rats and HAPI cells was analyzed by qRT-PCR. Protein expression of MK2, ionized calcium-binding adapter molecule-1 (Iba-1), tumor necrosis factor-alpha (TNF-α), and interleukin-1β (IL-1β) was assessed by western blot assay. The release of inflammatory cytokines TNF-α and IL-1β was measured by enzyme-linked immunosorbent assay (ELISA). The interaction between miR-24-3p and MK2 was examined by the luciferase reporter system. Basso-Beattie-Bresnahan (BBB) score dramatically reduced in rats following SCI compared with sham rats. Moreover, the expression of miR-24-3p was down-regulated, while MK2 was up-regulated in the spinal cord tissues of SCI rats and LPS-induced microglia cells compared with the corresponding control group. Luciferase reporter system confirmed the interaction between miR-24-3p and MK2. In addition, miR-24-3p upregulation or MK2 knockdown attenuated LPS induced activation of microglial cells and expression of inflammatory cytokine TNF-α and IL-1β. Besides, we discovered that miR-24-3p regulated inflammation of highly aggressively proliferating immortalized (HAPI) cells by targeting MK2.In our study, we clarified that miR-24-3p repressed inflammation of microglia cells following SCI by regulating MK2, thereby providing promising biomarkers for SCI therapy.
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Affiliation(s)
- Lin Zhao
- Department of Human Anatomy, Medical College of Yan'an University, Yan'an, 716000, Shaanxi, China
| | - Juan Shen
- Department of Human Anatomy, Medical College of Yan'an University, Yan'an, 716000, Shaanxi, China
| | - Kunpeng Jia
- Department of Pediatrics, Affiliated Hospital of Yan'an University, Yan'an, 716000, Shaanxi, China
| | - Fangfang Shi
- Department of Human Anatomy, Medical College of Yan'an University, Yan'an, 716000, Shaanxi, China
| | - Qin Hao
- Department of Nursing, Medical College of Yan'an University, Guanghua Road, Baota District, Yan'an, 716000, Shaanxi, China.
| | - Feng Gao
- Department of Physiology, Medical College of Yan'an University, Guanghua Road, Baota District, Yan'an, 716000, Shaanxi, China.
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Zhu F, Zeng L, Gui S, Liu Y, Wang Y, Cao X, Lin H, Yang L, Kong X, Guo X. The Role of Diffusion Tensor Imaging and Diffusion Tensor Tractography in the Assessment of Acute Traumatic Thoracolumbar Spinal Cord Injury. World Neurosurg 2021; 150:e23-e30. [PMID: 33561552 DOI: 10.1016/j.wneu.2021.01.146] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND This study explored diffusion tensor imaging (DTI) and diffusion tensor tractography (DTT) to assess the prognosis of thoracolumbar spinal cord injury (SCI). METHODS Twenty patients with acute traumatic thoracolumbar complete SCI (T1-L1, American Spinal Injury Association Impairment Scale [AIS] grade A) underwent conventional magnetic resonance imaging and DTI examinations. DTI measured the fractional anisotropy (FA) and apparent diffusion coefficient adjacent to the lesion epicenter. DTT was used to detect the white matter fiber morphology and measure the imaginary white matter fiber volume and connection rates of fiber tractography (CRFT). The patients' neurological functions were evaluated by the AIS grades. RESULTS At the final-follow-up, among the 20 patients with AIS grade A, 15 maintained the AIS grade (group A), and 5 patients showed improvement of AIS grade (group B). Group A's mean FA value was significantly lower than that of group B, whereas the mean apparent diffusion coefficient value among the 2 groups showed no significant difference. The white matter fibers of most patients in group A were completely ruptured (11/15), but the white matter fibers of all patients in group B were retained in different number (5/5). The mean CRFT of group B was significantly higher than that of group A (P < 0.05). The improvement of AIS grade was slightly positively correlated with FA values and highly positively correlated with CRFT. CONCLUSIONS The prognosis of complete thoracolumbar SCI may be related to the FA value and the CRFT. The application of DTI and DTT may optimize the diagnosis of thoracolumbar SCI.
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Affiliation(s)
- Fengzhao Zhu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Lian Zeng
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shan Gui
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yuan Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yulong Wang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaojian Cao
- Department of Spine Surgery, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, China
| | - Haodong Lin
- Department of Orthopaedics, Shanghai First People's Hospital, Shanghai Jiaotong University First People's Hospital, Shanghai, China
| | - Lian Yang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiangchuang Kong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaodong Guo
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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Radiological Risk Factors for Neurological Deficits After Traumatic Mid and Low Lumbar Fractures. Spine (Phila Pa 1976) 2020; 45:1513-1523. [PMID: 32694493 DOI: 10.1097/brs.0000000000003596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE We identified radiological risk factors for neurological deficits in mid and low lumbar spinal fractures. SUMMARY OF BACKGROUND DATA Although numerous studies have focused on radiological risk factors for neurological deficits in spinal cord injury or thoracolumbar junction area fractures, few have examined mid and low lumbar fractures at the cauda equina level. METHODS We retrospectively reviewed 71 consecutive patients who suffered acute traumatic mid and low lumbar fractures (L2-L5) corresponding to the cauda equina level, as confirmed on magnetic resonance imaging. We defined a neurological deficit as present if the patient had any sensory or motor deficit in the lower extremity or autonomic system at the initial assessment. Various computed tomography parameters of canal stenosis, vertebral body compression, sagittal alignment, interpedicular distance, and presence of vertical laminar fractures were analyzed as independent risk factors to predict neurological deficits using multivariate logistic regression analyses. RESULTS At the initial assessment, 31 patients had neurological deficits. Fracture level, AO fracture type, canal encroachment ratio, vertebral compression ratio, interpedicular distance ratio, and presence of a vertical laminar fracture were significantly associated with the presence of neurological deficits (all P < 0.05). Multivariate logistic regression identified fracture level, canal encroachment ratio (adjusted odds ratio [aOR] 1.072, 95% confidence interval [CI] 1.018-1.129), and vertebral compression ratio (aOR 0.884, 95% CI 0.788-0.992) as independent predictors of a neurological deficit. Receiver operating characteristic curve analyses revealed that only the canal encroachment ratio had good discriminatory ability (area under the curve 0.874, 95% CI 0.791-0.957), and the optimal cutoff was 47% (canal diameter 6.6 mm) with 90.3% sensitivity and 80% specificity. CONCLUSION The canal encroachment ratio was most strongly associated with neurological deficits in traumatic mid and low lumbar fractures, with an optimal cutoff of 47%. LEVEL OF EVIDENCE 4.
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22
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Lak AM, Rahimi A, Abunimer AM, Tafel I, Devi S, Premkumar A, Ida F, Lu Y, Chi JH, Tanguturi S, Groff MW, Zaidi HA. Quantifying the impact of surgical decompression on quality of life and identification of factors associated with outcomes in patients with symptomatic metastatic spinal cord compression. J Neurosurg Spine 2020; 33:237-244. [PMID: 32244218 DOI: 10.3171/2020.1.spine191326] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 01/27/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Metastatic spinal cord compression (MSCC) imposes significant impairment on patient quality of life and often requires immediate surgical intervention. In this study the authors sought to estimate the impact of surgical intervention on patient quality of life in the form of mean quality-adjusted life years (QALY) gained and identify factors associated with positive outcomes. METHODS The authors performed a retrospective chart review and collected data for patients who had neurological symptoms resulting from radiologically and histologically confirmed MSCC and were treated with surgical decompression during the last 12 years. RESULTS A total of 151 patients were included in this study (mean age 60.4 years, 57.6% males). The 5 most common metastatic tumor types were lung, multiple myeloma, renal, breast, and prostate cancer. The majority of patients had radioresistant tumors (82.7%) and had an active primary site at presentation (67.5%). The median time from tumor diagnosis to cord compression was 12 months and the median time from identification of cord compression to death was 4 months. Preoperative presenting symptoms included motor weakness (70.8%), pain (70.1%), sensory disturbances (47.6%), and bowel or bladder disturbance (31.1%). The median estimated blood loss was 500 mL and the average length of hospital stay was 10.3 days. About 18% of patients had postoperative complications and the mean follow-up was 7 months. The mean pre- and postoperative ECOG (Eastern Cooperative Oncology Group) performance status grades were 3.2 and 2.4, respectively. At follow-up, 58.3% of patients had improved status, 31.5% had no improvement, and 10.0% had worsening of functional status. The mean QALY gained per year in the entire cohort was 0.55. The mean QALY gained in the first 6 months was 0.1 and in the first year was 0.4. For patients who lived 1-2, 2-3, 3-4, or 4-5 years, the mean QALY gained were 0.8, 1.4, 1.7, and 2.3, respectively. Preoperative motor weakness, bowel dysfunction, bladder dysfunction, and ASA (American Society of Anesthesiologists) class were identified as independent predictors inversely associated with good outcome. CONCLUSIONS The mean QALY gained from surgical decompression in the first 6 months and first year equals 1.2 months and 5 months of life in perfect health, respectively. These findings suggest that surgery might also be beneficial to patients with life expectancy < 6 months.
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Affiliation(s)
- Asad M Lak
- 1Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Amina Rahimi
- 1Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Abdullah M Abunimer
- 1Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ian Tafel
- 1Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sharmila Devi
- 1Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- 2Faculty of Life Sciences and Medicine, King's College, London, United Kingdom
| | - Akash Premkumar
- 1Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Fidelia Ida
- 1Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- 3Massachusetts College of Pharmacy and Health Science, Boston; and
| | - Yi Lu
- 1Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - John H Chi
- 1Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Shyam Tanguturi
- 4Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michael W Groff
- 1Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hasan A Zaidi
- 1Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Yu Z, Sun X, Xia R, Chen Q, Wu Q, Zheng W. Modulation of inflammatory factors predicts the outcome following spinal cord injury. J Orthop Surg Res 2020; 15:199. [PMID: 32487194 PMCID: PMC7268366 DOI: 10.1186/s13018-020-01727-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/25/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The correlation between inflammatory responses caused by spinal cord injury (SCI) and the prognosis of patients with SCI still remains controversial. METHODS In the present study, we preliminary investigated the serum levels of interleukin (IL)-4, IL-10, major histocompatibility complex (MHC)-I, and inducible nitric oxide synthase (iNOS) and compared the serum IL-4 and IL-10 expression in rats of high Basso-Beattie-Bresnahan (BBB) scores with these of low BBB scores. Besides, the infiltration of macrophage and the axonal regeneration of the injured spinal cord were observed from day 10 to day 30. RESULTS We found that higher serum levels of IL-4 and IL-10 can reflect the restorability degree of SCI and could be potential biomarkers for the prognosis of SCI. The infiltration of the M2 subtype of macrophage and the axons regrowth might contribute to a better prognosis. CONCLUSIONS The current study demonstrates that the serum levels of IL-4 and IL-10 are preliminarily adopted as serologic markers to forecast SCI, and high serum levels of IL-4 and IL-10 may indicate a better prognosis. Moreover, the way to promote macrophage polarization from M1 to M2 may contribute to better axonal regeneration.
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Affiliation(s)
- Zepeng Yu
- Department of Intervention, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, People's Republic of China
| | - Xingwei Sun
- Department of Intervention, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, People's Republic of China
| | - Rui Xia
- Department of Oncology, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, People's Republic of China
| | - Qian Chen
- Department of Oncology, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, 215008, People's Republic of China
| | - Qin Wu
- Department of Ultrasonography, Suzhou Science and Technology Town Hospital, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, 215001, People's Republic of China.
| | - Weiwei Zheng
- Department of Orthopaedics, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, 215008, People's Republic of China.
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Morphological features of thoracolumbar burst fractures associated with neurological outcome in thoracolumbar traumatic spinal cord injury. 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 2020; 29:2505-2512. [PMID: 32424639 DOI: 10.1007/s00586-020-06420-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/15/2020] [Accepted: 04/11/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To identify specific morphological characteristics in thoracolumbar burst fractures associated with neurological outcome after severe traumatic spinal cord injury (TSCI). METHODS We retrospectively analyzed the clinical and radiological (CT scan morphological characteristics) data of 25 consecutive patients admitted for TSCI secondary to a burst fracture at levels from T11 to L2 between 2010 and 2017 in single level-1 trauma center. We included severe TSCI, defined as American Spinal Injury Association Impairment Scale (AIS) grade A, B or C. RESULTS Among the 25 patients with severe TSCI, 14 were AIS A, 5 were AIS B, and 6 were AIS C upon initial preoperative neurological evaluation. The AIS grade and the burden of associated injuries (Injury Severity Score, ISS) were the only clinical factors significantly associated with poor neurological recovery. The trauma level of energy was not associated with neurological outcome. Several fractures parameters were independently related to neurological recovery: the postero-inferior corner translation, presence of retropulsed fragment comminution and complete lamina fracture. The magnitude of sagittal kyphosis angle, vertebral kyphosis index and vertebral body comminution were not associated with the neurological outcome. CONCLUSIONS Morphological features of the bony structures involving the spinal canal in thoracolumbar burst fractures with severe TSCI are associated with the chronic neurological outcome and could provide more insight than the AIS clinical grading. The fracture pattern may better reflect the actual level of energy transferred to the spinal cord than distinguishing between low- and high-energy trauma.
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Predictors of Intraspinal Pressure and Optimal Cord Perfusion Pressure After Traumatic Spinal Cord Injury. Neurocrit Care 2020; 30:421-428. [PMID: 30328047 PMCID: PMC6420421 DOI: 10.1007/s12028-018-0616-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background/Objectives We recently developed techniques to monitor intraspinal pressure (ISP) and spinal cord perfusion pressure (SCPP) from the injury site to compute the optimum SCPP (SCPPopt) in patients with acute traumatic spinal cord injury (TSCI). We hypothesized that ISP and SCPPopt can be predicted using clinical factors instead of ISP monitoring. Methods Sixty-four TSCI patients, grades A–C (American spinal injuries association Impairment Scale, AIS), were analyzed. For 24 h after surgery, we monitored ISP and SCPP and computed SCPPopt (SCPP that optimizes pressure reactivity). We studied how well 28 factors correlate with mean ISP or SCPPopt including 7 patient-related, 3 injury-related, 6 management-related, and 12 preoperative MRI-related factors. Results All patients underwent surgery to restore normal spinal alignment within 72 h of injury. Fifty-one percentage had U-shaped sPRx versus SCPP curves, thus allowing SCPPopt to be computed. Thirteen percentage, all AIS grade A or B, had no U-shaped sPRx versus SCPP curves. Thirty-six percentage (22/64) had U-shaped sPRx versus SCPP curves, but the SCPP did not reach the minimum of the curve, and thus, an exact SCPPopt could not be calculated. In total 5/28 factors were associated with lower ISP: older age, excess alcohol consumption, nonconus medullaris injury, expansion duroplasty, and less intraoperative bleeding. In a multivariate logistic regression model, these 5 factors predicted ISP as normal or high with 73% accuracy. Only 2/28 factors correlated with lower SCPPopt: higher mean ISP and conus medullaris injury. In an ordinal multivariate logistic regression model, these 2 factors predicted SCPPopt as low, medium–low, medium–high, or high with only 42% accuracy. No MRI factors correlated with ISP or SCPPopt. Conclusions Elevated ISP can be predicted by clinical factors. Modifiable factors that may lower ISP are: reducing surgical bleeding and performing expansion duroplasty. No factors accurately predict SCPPopt; thus, invasive monitoring remains the only way to estimate SCPPopt. Electronic supplementary material The online version of this article (10.1007/s12028-018-0616-7) contains supplementary material, which is available to authorized users.
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Naduvanahalli Vivekanandaswamy A, Kannan M, Sharma V, Shetty AP, Maheswaran A, Kanna RM, Rajasekaran S. Prognostic utility of magnetic resonance imaging (MRI) in predicting neurological outcomes in patients with acute thoracolumbar spinal cord injury. 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 2019; 29:1227-1235. [PMID: 31501968 DOI: 10.1007/s00586-019-06135-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/10/2019] [Accepted: 09/03/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Utility of MRI for predicting neurological outcomes in acute cervical spinal cord injury (SCI) is well established but its value in thoracolumbar (TL) SCI needs to be evaluated. METHODS Seventy-six patients operated for acute TL spinal injuries between January 2014 and March 2016 were reviewed to obtain demographic details, neurology at admission and at the final follow-up. Patients were divided based on the neurology at presentation into group 1 (ASIA A), group 2 (ASIA B, C, D) and group 3 (normal neurology). Preoperative MRI and CT scans were evaluated to measure parameters like osseus canal compromise, spinal cord compression (SCC), spinal cord swelling, length of cord swelling (LOS), length of edema (LOE) and the presence of hemorrhage. The MRI parameters were compared between the groups for their predictive value of neurology on admission and at the final follow-up. RESULTS Of the 38 patients in group 1, six patients recovered by 1 grade, nine patients recovered by 2 grades and there was no recovery in 23 (60.5%) patients. Among group 2 patients, nine (40.9%) out of 22 recovered to ASIA E neurology. On univariate analysis, SCC (P = 0.009), LOS (P = 0.021) and length of edema (P = 0.002) were associated with complete neurological deficit at presentation. However, on multivariate regression analysis only LOE was significant (P = 0.007) in predicting neurology at admission and at follow-up. CONCLUSION Greater the rostrocaudal LOE, worse is the neurology at presentation, and it is associated with poor neurological recovery at follow-up. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
| | - Muhil Kannan
- Department of Radiodiagnosis, Ganga Medical Centre and Hospitals Pvt. Ltd, Mettupalayam Road, Coimbatore, 641001, India
| | - Vyom Sharma
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd, Mettupalayam Road, Coimbatore, 641001, India
| | - Ajoy Prasad Shetty
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd, Mettupalayam Road, Coimbatore, 641001, India. .,Department of Orthopaedics and Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd, #313, Mettupalayam Road, Coimbatore, Tamilnadu, 641001, India.
| | - Anupama Maheswaran
- Department of Radiodiagnosis, Ganga Medical Centre and Hospitals Pvt. Ltd, Mettupalayam Road, Coimbatore, 641001, India
| | - Rishi Mugesh Kanna
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd, Mettupalayam Road, Coimbatore, 641001, India
| | - Shanmuganathan Rajasekaran
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd, Mettupalayam Road, Coimbatore, 641001, India
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Wutte C, Klein B, Becker J, Mach O, Panzer S, Strowitzki M, Maier D, Grassner L. Earlier Decompression (< 8 Hours) Results in Better Neurological and Functional Outcome after Traumatic Thoracolumbar Spinal Cord Injury. J Neurotrauma 2019; 36:2020-2027. [DOI: 10.1089/neu.2018.6146] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Christof Wutte
- Center for Spinal Cord Injuries, Trauma Center Murnau, Murnau, Germany
| | - Barbara Klein
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg, Salzburg, Austria
| | - Johannes Becker
- Center for Spinal Cord Injuries, Trauma Center Murnau, Murnau, Germany
- Institute of Biomechanics, BG Trauma Center Murnau, Germany, and Paracelsus Medical University, Salzburg, Austria
| | - Orpheus Mach
- Center for Spinal Cord Injuries, Trauma Center Murnau, Murnau, Germany
| | - Stephanie Panzer
- Department of Radiology, Trauma Center Murnau, Murnau, Germany
- Institute of Biomechanics, BG Trauma Center Murnau, Germany, and Paracelsus Medical University, Salzburg, Austria
| | | | - Doris Maier
- Center for Spinal Cord Injuries, Trauma Center Murnau, Murnau, Germany
| | - Lukas Grassner
- Center for Spinal Cord Injuries, Trauma Center Murnau, Murnau, Germany
- Department of Neurosurgery, Trauma Center Murnau, Murnau, Germany
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg, Salzburg, Austria
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The relevance of MRI for predicting neurological recovery following cervical traumatic spinal cord injury. Spinal Cord 2019; 57:866-873. [DOI: 10.1038/s41393-019-0295-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 04/24/2019] [Accepted: 04/24/2019] [Indexed: 11/08/2022]
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MR Imaging for Assessing Injury Severity and Prognosis in Acute Traumatic Spinal Cord Injury. Radiol Clin North Am 2019; 57:319-339. [DOI: 10.1016/j.rcl.2018.09.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Spine trauma: what residents need to know. CURRENT ORTHOPAEDIC PRACTICE 2018. [DOI: 10.1097/bco.0000000000000676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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