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Mahdavi A, Rasti S. Dynamic Flexion-Extension Magnetic Resonance Imaging of the Cervical Spine: An Evolutionary Tool for Diagnosis and Management of Cervical Spondylotic Myelopathy. World Neurosurg 2024; 184:138-147. [PMID: 38246532 DOI: 10.1016/j.wneu.2024.01.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/14/2024] [Accepted: 01/16/2024] [Indexed: 01/23/2024]
Abstract
Dynamic problems need dynamic solutions. High motility of the cervical spine causes a common age-related degenerative condition called cervical spondylotic myelopathy (CSM), manifested by neurological impairments. An accurate and reliable diagnosis of CSM is crucial for determining appropriate management strategies. Traditional static magnetic resonance imaging (MRI) has been the gold standard for imaging CSM; however, it may not fully capture dynamic changes during neck movement. Dynamic flexion-extension (DFE) MRI is an innovative imaging technique that allows for real-time visualization of cervical spine motion. This review article aims to scrutinize the role of DFE MRI in assessing CSM, its added value to clinical implementations, and its limitations. Finally, by addressing the knowledge gaps, this survey sheds light on the road ahead to incorporate DFE MRI into a standard version of the practice.
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Affiliation(s)
- Ali Mahdavi
- Department of Radiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sina Rasti
- Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
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2
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Malhotra AK, Shakil H, Harrington EM, Fehlings MG, Wilson JR, Witiw CD. Early surgery compared to nonoperative management for mild degenerative cervical myelopathy: a cost-utility analysis. Spine J 2024; 24:21-31. [PMID: 37302415 DOI: 10.1016/j.spinee.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 05/10/2023] [Accepted: 06/03/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND CONTEXT Degenerative cervical myelopathy (DCM) is a form of acquired spinal cord compression and contributes to reduced quality of life secondary to neurological dysfunction and pain. There remains uncertainty regarding optimal management for individuals with mild myelopathy. Specifically, owing to lacking long-term natural history studies in this population, we do not know whether these individuals should be treated with initial surgery or observation. PURPOSE We sought to perform a cost-utility analysis to examine early surgery for mild degenerative cervical myelopathy from the healthcare payer perspective. STUDY DESIGN/SETTING We utilized data from the prospective observational cohorts included in the Cervical Spondylotic Myelopathy AO Spine International and North America studies to determine health related quality of life estimates and clinical myelopathy outcomes. PATIENT SAMPLE We recruited all patients that underwent surgery for DCM enrolled in the Cervical Spondylotic Myelopathy AO Spine International and North America studies between December 2005 and January 2011. OUTCOME MEASURES Clinical assessment measures were obtained using the Modified Japanese Orthopedic Association scale and health-related quality of life measures were obtained using the Short Form-6D utility score at baseline (preoperative), 6 months, 12 months and 24 months postsurgery. Cost measures inflated to January 2015 values were obtained using pooled estimates from the hospital payer perspective for surgical patients. METHODS We employed a Markov state transition model with Monte Carlo microsimulation using a lifetime horizon to obtain an incremental cost utility ratio associated with early surgery for mild myelopathy. Parameter uncertainty was assessed through deterministic means using one-way and two-way sensitivity analyses and probabilistically using parameter estimate distributions with microsimulation (10,000 trials). Costs and utilities were discounted at 3% per annum. RESULTS Initial surgery for mild degenerative cervical myelopathy was associated with an incremental lifetime increase of 1.26 quality-adjusted life years (QALY) compared to observation. The associated cost incurred to the healthcare payer over a lifetime horizon was $12,894.56, resulting in a lifetime incremental cost-utility ratio of $10,250.71/QALY. Utilizing a willingness to pay threshold in keeping with the World Health Organization definition of "very cost-effective" ($54,000 CDN), the probabilistic sensitivity analysis demonstrated that 100% of cases were cost-effective. CONCLUSIONS Surgery compared to initial observation for mild degenerative cervical myelopathy was cost-effective from the Canadian healthcare payer perspective and was associated with lifetime gains in health-related quality of life.
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Affiliation(s)
- Armaan K Malhotra
- Division of Neurosurgery, Department of Surgery, University of Toronto, 149 College St, Toronto, Ontario, M5T 1P5, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada; Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Ontario, M5T 3M6, Canada
| | - Husain Shakil
- Division of Neurosurgery, Department of Surgery, University of Toronto, 149 College St, Toronto, Ontario, M5T 1P5, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada; Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Ontario, M5T 3M6, Canada
| | - Erin M Harrington
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada
| | - Michael G Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, 149 College St, Toronto, Ontario, M5T 1P5, Canada; Krembil Research Institute, Toronto Western Hospital, 60 Leonard Ave, Toronto, Ontario, M5T 0S8, Canada
| | - Jefferson R Wilson
- Division of Neurosurgery, Department of Surgery, University of Toronto, 149 College St, Toronto, Ontario, M5T 1P5, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada; Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Ontario, M5T 3M6, Canada
| | - Christopher D Witiw
- Division of Neurosurgery, Department of Surgery, University of Toronto, 149 College St, Toronto, Ontario, M5T 1P5, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada; Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Ontario, M5T 3M6, Canada.
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Awuah WA, Ahluwalia A, Ghosh S, Roy S, Tan JK, Adebusoye FT, Ferreira T, Bharadwaj HR, Shet V, Kundu M, Yee ALW, Abdul-Rahman T, Atallah O. The molecular landscape of neurological disorders: insights from single-cell RNA sequencing in neurology and neurosurgery. Eur J Med Res 2023; 28:529. [PMID: 37974227 PMCID: PMC10652629 DOI: 10.1186/s40001-023-01504-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023] Open
Abstract
Single-cell ribonucleic acid sequencing (scRNA-seq) has emerged as a transformative technology in neurological and neurosurgical research, revolutionising our comprehension of complex neurological disorders. In brain tumours, scRNA-seq has provided valuable insights into cancer heterogeneity, the tumour microenvironment, treatment resistance, and invasion patterns. It has also elucidated the brain tri-lineage cancer hierarchy and addressed limitations of current models. Neurodegenerative diseases such as Alzheimer's disease, Parkinson's disease, and amyotrophic lateral sclerosis have been molecularly subtyped, dysregulated pathways have been identified, and potential therapeutic targets have been revealed using scRNA-seq. In epilepsy, scRNA-seq has explored the cellular and molecular heterogeneity underlying the condition, uncovering unique glial subpopulations and dysregulation of the immune system. ScRNA-seq has characterised distinct cellular constituents and responses to spinal cord injury in spinal cord diseases, as well as provided molecular signatures of various cell types and identified interactions involved in vascular remodelling. Furthermore, scRNA-seq has shed light on the molecular complexities of cerebrovascular diseases, such as stroke, providing insights into specific genes, cell-specific expression patterns, and potential therapeutic interventions. This review highlights the potential of scRNA-seq in guiding precision medicine approaches, identifying clinical biomarkers, and facilitating therapeutic discovery. However, challenges related to data analysis, standardisation, sample acquisition, scalability, and cost-effectiveness need to be addressed. Despite these challenges, scRNA-seq has the potential to transform clinical practice in neurological and neurosurgical research by providing personalised insights and improving patient outcomes.
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Affiliation(s)
- Wireko Andrew Awuah
- Faculty of Medicine, Sumy State University, Zamonstanksya 7, Sumy, 40007, Ukraine
| | | | - Shankaneel Ghosh
- Institute of Medical Sciences and SUM Hospital, Bhubaneswar, India
| | - Sakshi Roy
- School of Medicine, Queen's University Belfast, Belfast, UK
| | | | | | - Tomas Ferreira
- Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | | | - Vallabh Shet
- Faculty of Medicine, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
| | - Mrinmoy Kundu
- Institute of Medical Sciences and SUM Hospital, Bhubaneswar, India
| | | | - Toufik Abdul-Rahman
- Faculty of Medicine, Sumy State University, Zamonstanksya 7, Sumy, 40007, Ukraine
| | - Oday Atallah
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
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Kim Y, Jeong M, Park MW, Shin HI, Lee BC, Kim DH. Incidence and risk factors of deep vein thrombosis and pulmonary thromboembolism after spinal cord disease at a rehabilitation unit: a retrospective study. J Yeungnam Med Sci 2023; 40:S56-S64. [PMID: 37726959 DOI: 10.12701/jyms.2023.00689] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/03/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE) are major complications of spinal cord disease. However, studies of their incidence in Korean patients are limited. Thus, this study investigated the incidence and risk factors of DVT and PTE in Korean patients with spinal cord disease. METHODS We retrospectively analyzed the medical records of 271 patients with spinal cord disease who were admitted to a rehabilitation unit within 3 months of disease onset at a tertiary hospital. The presence of DVT and PTE was mainly determined using Doppler ultrasonography and chest embolism computed tomography. Risk factor analysis included variables such as sex, age, obesity, completeness of motor paralysis, neurological level of injury, cause of injury, lower extremity fracture, active cancer, and functional ambulation category (FAC) score. RESULTS The incidences of DVT and PTE in the patients with spinal cord disease were both 6.3%. Risk factor analysis revealed that age of ≥65 years (p=0.031) and FAC score of ≤1 (p=0.023) were significantly associated with DVT development. Traumatic cause of injury (p=0.028) and DVT (p<0.001) were significant risk factors of PTE. CONCLUSION Patients with spinal cord disease developed DVT and PTE within 3 months of disease onset with incidence rates of 6.3% and 6.3%, respectively. Age of ≥65 years and an FAC of score ≤1 were risk factors for DVT. Traumatic cause of injury and DVT were risk factors for PTE. However, given the inconsistent results of previous studies, the risk factors for DVT and PTE remain inconclusive. Therefore, early screening for DVT and PTE should be performed in patients with acute-to-subacute spinal cord disease regardless of the presence or absence of these risk factors.
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Affiliation(s)
- Yoonhee Kim
- Department of Physical and Rehabilitation Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Minjae Jeong
- Department of Physical and Rehabilitation Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Myung Woo Park
- Department of Physical and Rehabilitation Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyun Iee Shin
- Department of Physical and Rehabilitation Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Byung Chan Lee
- Department of Physical and Rehabilitation Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Du Hwan Kim
- Department of Physical and Rehabilitation Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
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Harder M, Baumberger M, Pannek J, Decker J, Bersch I. [Rehabilitation after Spinal Cord Injury : Current trends and principles]. Unfallchirurgie (Heidelb) 2023; 126:764-773. [PMID: 37608182 DOI: 10.1007/s00113-023-01360-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 08/24/2023]
Abstract
Traumatic and non traumatic spinal cord injury are rare and an orphan disease in comparison to common diseases. Those affected represent a very special patient population in the treatment even at the site of the accident and in emergency medicine and require a high level of professional expertise. The rehabilitation with the complexity of a spinal cord injury can only succeed with a multiprofessional team that is less focused on the often similar diagnoses according to the International Classification of Diseases (ICD) but on functional disorders and associated activity impairments. Only then the best possible integration and participation/inclusion in sociocultural and professional life can be achieved. In addition to the importance of classical physiotherapy and occupational therapy, this article highlights important but often missing team players, such as neurourology and electrical stimulation. In addition, the problems of frequent and some less recognized complications, such as autonomic dysfunction and the benefits of airway management are highlighted. For a comprehensive overview of rehabilitation in spinal cord injury, reference textbooks and guidelines are recommended that are cited in the text.
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Affiliation(s)
- M Harder
- Schweizer Paraplegiker Zentrum, Guido A. Zäch-Str. 1, 6207, Nottwil, Schweiz.
| | | | | | | | - I Bersch
- Schweizer Paraplegiker Zentrum, Guido A. Zäch-Str. 1, 6207, Nottwil, Schweiz.
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Peña I, Sarmiento J, Porras C, Cediel X, Camargo A. Myelopathy due to copper deficiency: A case series and review of the literature. Biomedica 2023; 43:171-180. [PMID: 37433165 PMCID: PMC10503487 DOI: 10.7705/biomedica.6687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 06/05/2023] [Indexed: 07/13/2023]
Abstract
Copper deficiency can present as myelopathy by the manifestation of sensory ataxia, secondary to demyelination of the posterior cords of the spinal cord, accompanied by cytopenia, mainly anemia, and leukopenia. Case series study of three patients with myelopathy due to copper deficiency, diagnosed and managed from 2020 to 2022 in a highly complex university hospital in Colombia. Regarding gender, two cases were female patients. The age range was between 57 and 68 years. In all three cases serum copper levels were decreased, and in two of these, different causes of myelopathy affecting the posterior cords of the spinal cord were ruled out, such as vitamin B12, vitamin E and folic acid deficiency, tabes dorsalis, myelopathy due to human immunodeficiency virus, multiple sclerosis and infection by the human lymphotropic virus type I and II, among others. However, at the moment of the myelopathy diagnosis, one patient had vitamin B12 deficiency associated with copper insufficiency. All three cases presented sensory ataxia, and in two, paraparesis was the initial motor deficit. The diagnostic approach must include copper levels assessment in every case of patients with chronic gastrointestinal pathology, chronic diarrhea, malabsorption syndrome, or significant reduction in dietary intake; and the development of neurological symptoms that may suggest cord involvement. It has been reported that a delay in diagnosis can lead to poor neurological outcomes.
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Affiliation(s)
- Iván Peña
- Fundación Oftalmológica de Santander (FOSCAL), Bucaramanga, Colombia; Facultad de Ciencias de la Salud, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia.
| | - Juan Sarmiento
- Fundación Oftalmológica de Santander (FOSCAL), Bucaramanga, Colombia; Facultad de Ciencias de la Salud, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia.
| | - Cristian Porras
- Fundación Oftalmológica de Santander (FOSCAL), Bucaramanga, Colombia; Facultad de Ciencias de la Salud, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia.
| | - Ximena Cediel
- Fundación Oftalmológica de Santander (FOSCAL), Bucaramanga, Colombia.
| | - Ana Camargo
- Fundación Oftalmológica de Santander (FOSCAL), Bucaramanga, Colombia; Facultad de Ciencias de la Salud, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia.
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Kim KD, Coric D, Khachatryan A, Brady BL, Lillehaugen T, McCormack M, Dolman WB, Ditto R. A real-world analysis of hybrid CDA and ACDF compared to multilevel ACDF. BMC Musculoskelet Disord 2023; 24:191. [PMID: 36918916 PMCID: PMC10012503 DOI: 10.1186/s12891-023-06284-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 03/01/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND Multilevel anterior cervical discectomy and fusion (mACDF) is the gold standard for multilevel spinal disease; although safe and effective, mACDF can limit regular spinal motion and contribute to adjacent segment disease (ASD). Hybrid surgery, composed of ACDF and cervical disc arthroplasty, has the potential to reduce ASD by retaining spinal mobility. This study examined the safety of hybrid surgery by utilizing administrative claims data to compare real-world rates of subsequent surgery and post-procedural hospitalization within populations of patients undergoing hybrid surgery versus mACDF for multilevel spinal disease. METHODS This observational, retrospective analysis used the MarketScan Commercial and Medicare Database from July 2013 through June 2020. Propensity score matched cohorts of patients who received hybrid surgery or mACDF were established based on the presence of spinal surgery procedure codes in the claims data and followed over a variable post-period. Rates of subsequent surgery and post-procedural hospitalization (30- and 90-day) were compared between hybrid surgery and mACDF cohorts. RESULTS A total of 430 hybrid surgery patients and 2,136 mACDF patients qualified for the study; average follow-up was approximately 2 years. Similar rates of subsequent surgery (Hybrid: 1.9 surgeries/100 patient-years; mACDF: 1.8 surgeries/100 patient-years) were observed for the two cohorts. Hospitalization rates were also similar across cohorts at 30 days post-procedure (Hybrid: 0.67% hospitalized/patient-year; mACDF: 0.87% hospitalized/patient-year). At 90 days post-procedure, hybrid surgery patients had slightly lower rates of hospitalization compared to mACDF patients (0.23% versus 0.42% hospitalized/patient-year; p < 0.05). CONCLUSIONS Findings of this real-world, retrospective cohort study confirm prior reports indicating that hybrid surgery is a safe and effective intervention for multilevel spinal disease which demonstrates non-inferiority in relation to the current gold standard mACDF. The use of administrative claims data in this analysis provides a unique perspective allowing the inclusion of a larger, more generalizable population has historically been reported on in small cohort studies.
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Affiliation(s)
- Kee D Kim
- UC Davis Health, 4860 Y Street Suite, Sacramento, CA, 3740, 95817, USA
| | - Domagoj Coric
- Atrium Musculoskeletal Institute, Spine Division, Carolina Neurosurgery and Spine Associates, 225 Baldwin Avenue Charlotte, Charlotte, NC, 28204, USA
| | - Armen Khachatryan
- Orthopedic Spine Surgery, The Disc Replacement Center, 3584 West 9000 South #209, Salt Lake City, UT, 84088, USA
| | | | | | - Mike McCormack
- Zimmer Biomet, 1800 W Center Street, Warsaw, IN, 46580, USA
| | | | - Richard Ditto
- Zimmer Biomet, 1800 W Center Street, Warsaw, IN, 46580, USA
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Rottler A, Dang YL, Hooi WF, Burrows D, Kok HK, Crompton D. Cervical cord infarction mimicking migraine in a patient with vertebral artery dissection. Med J Aust 2023; 218:111-112. [PMID: 36573433 DOI: 10.5694/mja2.51814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 12/28/2022]
Affiliation(s)
| | | | - Wai Foong Hooi
- Northern Health, Melbourne, VIC.,Austin Health, Melbourne, VIC
| | | | - Hong Kuan Kok
- Northern Health, Melbourne, VIC.,Deakin University, Melbourne, VIC
| | - Douglas Crompton
- Northern Health, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
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Senthinathan A, Cronin SM, Ho C, New PW, Guilcher SJ, Noonan VK, Craven BC, Christie S, Wai EK, Tsai EC, Sreenivasan V, Wilson J, Fehlings MG, Welk B, Jaglal SB. Using Clinical Vignettes and a Modified Expert Delphi Panel to Determine Parameters for Identifying Non-Traumatic Spinal Cord Injury in Health Administrative and Electronic Medical Record Databases. Arch Phys Med Rehabil 2023; 104:63-73. [PMID: 36002056 DOI: 10.1016/j.apmr.2022.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To obtain expert consensus on the parameters and etiologic conditions required to retrospectively identify cases of non-traumatic spinal cord injury (NTSCI) in health administrative and electronic medical record (EMR) databases based on the rating of clinical vignettes. DESIGN A modified Delphi process included 2 survey rounds and 1 remote consensus panel. The surveys required the rating of clinical vignettes, developed after chart reviews and expert consultation. Experts who participated in survey rounds were invited to participate in the Delphi Consensus Panel. SETTING An international collaboration using an online meeting platform. PARTICIPANTS Thirty-one expert physicians and/or clinical researchers in the field of spinal cord injury (SCI). MAIN OUTCOME MEASURE(S) Agreement on clinical vignettes as NTSCI. Parameters to classify cases of NTSCI in health administrative and EMR databases. RESULTS In health administrative and EMR databases, cauda equina syndromes should be considered SCI and classified as a NTSCI or TSCI based on the mechanism of injury. A traumatic event needs to be listed for injury to be considered TSCI. To be classified as NTSCI, neurologic sufficient impairments (motor, sensory, bowel, and bladder) are required, in addition to an etiology. It is possible to have both a NTSCI and a TSCI, as well as a recovered NTSCI. If information is unavailable or missing in health administrative and EMR databases, the case may be listed as "unclassifiable" depending on the purpose of the research study. CONCLUSION The Delphi panel provided guidelines to appropriately classify cases of NTSCI in health administrative and EMR databases.
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Affiliation(s)
- Arrani Senthinathan
- From the Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada; KITE (Knowledge Innovation Talent Everywhere), Toronto Rehabilitation Institute - University Health Network, Toronto, Canada.
| | - Shawna M Cronin
- From the Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada; KITE (Knowledge Innovation Talent Everywhere), Toronto Rehabilitation Institute - University Health Network, Toronto, Canada
| | - Chester Ho
- Division of Physical Medicine & Rehabilitation, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Peter W New
- Spinal Rehabilitation Service, Caulfield Hospital, Alfred Health, Caulfield, Australia; Department of Medicine & Rehabilitation and Aged Services Program, Kingston Centre, Monash Health, Cheltenham, Australia; Epworth-Monash Rehabilitation Medicine Unit, Monash University, Richmond, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Prahran, Australia
| | - Sara Jt Guilcher
- From the Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada; Rehabilitation Science Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Vanessa K Noonan
- Praxis Spinal Cord Institute, Vancouver, Canada; International Collaboration on Repair Discoveries, Vancouver, Canada
| | - B Catherine Craven
- KITE (Knowledge Innovation Talent Everywhere), Toronto Rehabilitation Institute - University Health Network, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute - University Health Network, Toronto, Canada
| | - Sean Christie
- Division of Neurosurgery, Dalhousie University, Halifax, Canada
| | - Eugene K Wai
- Division of Orthopaedic Surgery and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Eve C Tsai
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada; Division of Neurosurgery, University of Ottawa, The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Vidya Sreenivasan
- Physical Medicine and Rehabilitation, The Ottawa Hospital, Ottawa, Canada
| | - Jefferson Wilson
- Division of Neurosurgery, University of Toronto, Toronto, Canada; St. Michael's Hospital, Toronto, Canada
| | - Michael G Fehlings
- Division of Neurosurgery, University of Toronto, Toronto, Canada; Department of Surgery and Epidemiology & Biostatistics, Western University, London, Canada
| | - Blayne Welk
- Division of Neurosurgery and Division of Genetics and Development, Krembil Neuroscience Centre, University Health Network, Toronto, Canada
| | - Susan B Jaglal
- From the Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada; KITE (Knowledge Innovation Talent Everywhere), Toronto Rehabilitation Institute - University Health Network, Toronto, Canada; Rehabilitation Science Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
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10
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Zhou LL, Zhu SG, Fang Y, Huang SS, Huang JF, Hu ZD, Chen JY, Zhang X, Wang JY. Neck pain and absence of cranial nerve symptom are clues of cervical myelopathy mimicking stroke: Two case reports. World J Clin Cases 2022; 10:11835-11844. [PMID: 36405285 PMCID: PMC9669878 DOI: 10.12998/wjcc.v10.i32.11835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/27/2022] [Accepted: 08/25/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cervical myelopathy is a potential stroke imitator, for which intravenous thrombolysis would be catastrophic.
CASE SUMMARY We herein present two cases of cervical myelopathy. The first patient presented with acute onset of right hemiparesis and urinary incontinence, and the second patient presented with sudden-onset right leg monoplegia. The initial diagnoses for both of them were ischemic stroke. However, both of them lacked cranial nerve symptom and suffered neck pain at the beginning of onset. Their cervical spinal cord lesions were finally confirmed by cervical computed tomography. A literature review showed that neck pain and absence of cranial nerve symptom are clues of cervical myelopathy.
CONCLUSION The current report and the review remind us to pay more attention to these two clues in suspected stroke patients, especially those within the thrombolytic time window.
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Affiliation(s)
- Li-Li Zhou
- Institute of Geriatric Neurology, Department of Neurology, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Shi-Guo Zhu
- Institute of Geriatric Neurology, Department of Neurology, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Yuan Fang
- Institute of Geriatric Neurology, Department of Neurology, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Shi-Shi Huang
- Institute of Geriatric Neurology, Department of Neurology, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Jie-Fan Huang
- Institute of Geriatric Neurology, Department of Neurology, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Ze-Di Hu
- Institute of Geriatric Neurology, Department of Neurology, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Jin-Yu Chen
- Institute of Geriatric Neurology, Department of Neurology, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Xiong Zhang
- Institute of Geriatric Neurology, Department of Neurology, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Jian-Yong Wang
- Institute of Geriatric Neurology, Department of Neurology, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
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11
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Santoso DN, Sinuraya FAG, Ambarsari CG. Distal renal tubular acidosis presenting with an acute hypokalemic paralysis in an older child with severe vesicoureteral reflux and syringomyelia: a case report. BMC Nephrol 2022; 23:248. [PMID: 35836135 PMCID: PMC9284770 DOI: 10.1186/s12882-022-02874-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 07/03/2022] [Indexed: 11/23/2022] Open
Abstract
Background Distal renal tubular acidosis (dRTA) is the most common type of renal tubular acidosis (RTA) in children. Pediatric dRTA is usually genetic and rarely occurs due to acquired issues such as obstructive uropathies, recurrent urinary tract infections (UTIs), and chronic kidney disease (CKD). Although persistent hypokalemia frequently occurs with dRTA, acute hypokalemic paralysis is not frequently reported, especially in older children. Case presentation An eight-year-old girl presented with an acute first episode of paralysis. A physical examination revealed normal vital signs, short stature consistent with her genetic potential, and decreased muscle strength of her upper and lower extremities. Preexisting conditions included stage 4 CKD due to recurrent UTIs, severe vesicoureteral reflux and bilateral hydronephrosis, neurogenic bladder, and multisegment thoracic syringomyelia. Her laboratory work-up revealed hypokalemic, hyperchloremic metabolic acidosis with a normal anion gap. She also had a urine osmolal gap of 1.9 mOsmol/kg with a high urine pH. Intravenous potassium replacement resulted in a complete resolution of her paralysis. She was diagnosed with dRTA and discharged with oral bicarbonate and slow-release potassium supplementation. Conclusions This case report highlights the importance of considering dRTA in the differential diagnosis of hypokalemic acute paralysis in children. Additionally, in children with neurogenic lower urinary tract dysfunction and recurrent UTIs, early diagnosis of spinal cord etiology is crucial to treat promptly, slow the progression of CKD, and prevent long-term complications such as RTA.
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Affiliation(s)
- Dara Ninggar Santoso
- Department of Child Health, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital Diponegoro, 71 Jakarta Pusat, 10430, Jakarta, Indonesia
| | - Fira Alyssa Gabriella Sinuraya
- Department of Child Health, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital Diponegoro, 71 Jakarta Pusat, 10430, Jakarta, Indonesia
| | - Cahyani Gita Ambarsari
- Department of Child Health, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital Diponegoro, 71 Jakarta Pusat, 10430, Jakarta, Indonesia. .,School of Medicine, University of Nottingham, Nottingham, UK. .,Medical Technology Cluster, Indonesian Medical Education and Research Institute (IMERI), Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.
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12
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El Khoury M, Mowforth OD, El Khoury A, Partha-Sarathi C, Hirayama Y, Davies BM, Kotter MR. Tremor as a symptom of degenerative cervical myelopathy: a systematic review. Br J Neurosurg 2022; 36:340-345. [PMID: 35132923 DOI: 10.1080/02688697.2022.2033701] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AO Spine RECODE-DCM (Research objectives and common data elements for degenerative cervical myelopathy) has highlighted that the subjective disability reported by people living with DCM is much broader than routinely considered today by most professionals. This includes a description of tremor. The objective of this review was to study the incidence and possible aetiology of tremor in degenerative cervical myelopathy (DCM). METHODS A systematic review registered in PROSPERO (CRD42020176905) was conducted in Embase and MEDLINE for papers studying tremor and DCM published on or before the 20th of July 2020. All manuscripts describing an association between tremor and DCM in humans were included. Articles relating to non-human animals, and those not available in English were excluded. An analysis was conducted in accordance with PRISMA and SWiM guidelines for systematic reviews. RESULTS Out of a total of 4402 screened abstracts, we identified 7 case reports and series describing tremor in 9 DCM patients. Papers were divided into three groups for the discussion. The first group includes DCM correctly identified on presentation, with tremor as a described symptom. The second group includes cases where DCM was misdiagnosed, often as Parkinson's disease. The third group includes a single case with a previous history of DCM, presenting with an otherwise unexplained tremor. This grouping allows for the clustering of cases supporting various arguments for the association between tremor and DCM. CONCLUSION DCM can be associated with tremor. The current evidence is restricted to case series. Further study is warranted to establish tremor prevalence, and its significance to assessment and management.
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Affiliation(s)
- Marc El Khoury
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Oliver D Mowforth
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Anthony El Khoury
- Southwest Indiana Internal Medicine Residency, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Yuri Hirayama
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Benjamin M Davies
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Mark R Kotter
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Anne McLaren Laboratory for Regenerative Medicine, Wellcome Trust-Medical Research Council Cambridge Stem Cell Institute, University of Cambridge, Cambridge, UK
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13
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Kubota S, Kadone H, Shimizu Y, Koda M, Takahashi H, Miura K, Eto F, Furuya T, Sankai Y, Yamazaki M. Immediate effects of hybrid assistive limb gait training on lower limb function in a chronic myelopathy patient with postoperative late neurological deterioration. BMC Res Notes 2022; 15:89. [PMID: 35246256 PMCID: PMC8896224 DOI: 10.1186/s13104-022-05979-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/18/2022] [Indexed: 11/21/2022] Open
Abstract
Objective The Hybrid Assistive Limb (HAL) has recently been used to treat movement disorders. Although studies have shown its effectiveness for chronic myelopathy, the immediate effects of HAL gait training on lower limb function have not been clarified. We conducted HAL gait training and examined its immediate effects on a 69-year-old man with re-deterioration of myelopathy in the chronic phase after surgery for compression myelopathy. The HAL intervention was performed every 4 weeks for 10 total sessions. Immediately before and after each session, we analyzed the patient’s walking ability using the 10-m walk test. In the 4th HAL session, the gastrocnemius muscle activity was measured bilaterally using a synchronized motion capture-electromyogram system. Results The training effects became steady after the 2nd session. In sessions 2–10, the step length increased from 0.56 to 0.63 m (mean: 0.031 m) immediately after HAL training. The motion capture-electromyogram analyses showed that considerable amounts of gastrocnemius muscle activity were detected during the stance and swing phases before HAL training. During and immediately after HAL training, gastrocnemius activity during the swing phase was diminished. HAL gait training has an immediate effect for inducing a normal gait pattern with less spasticity in those with chronic myelopathy. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-022-05979-4.
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Affiliation(s)
- Shigeki Kubota
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Hideki Kadone
- Center for Innovative Medicine and Engineering, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yukiyo Shimizu
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, 305-8575, Japan
| | - Masao Koda
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Hiroshi Takahashi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Kousei Miura
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Fumihiko Eto
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Takeo Furuya
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, Chiba, 260-8677, Japan
| | - Yoshiyuki Sankai
- Faculty of Engineering, Information and Systems, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8573, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
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14
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Mühlbauer J, Klotz D, Büttner S, Stein R, Younsi N. Bladder cancer in patients with neurogenic bladder disorder: a comparative study of different etiologies. World J Urol 2022; 40:1929-1937. [PMID: 35034168 DOI: 10.1007/s00345-021-03922-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/27/2021] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The objective of this study was to conduct a comparative study of different etiologies of neurogenic bladder disorders (NBDs) in patients with bladder cancer (BC) regarding patient- and tumor-related parameters and their oncological outcome. METHODS Out of 98 patients with bladder tumors and neurogenic disease, 23 patients with BC and NBDs from Jan 1, 2010, to Dec 31, 2020, were included. The different etiologies of NBDs were merged in three groups based on the level of the nervous system (NS)-lesion: (i) central (n = 6), (ii) spinal cord (n = 10), and (iii) peripheral lesions (n = 7). RESULTS Patients with lesions at the spinal cord level were younger at the time of BC diagnosis compared to patients with central or peripheral NS lesions (54 vs. 68 vs. 78 years, p = 0.0219). However, the latency to malignant transformation was more than twice as long (33 vs. 15 years, p = 0.0108). Most tumors were muscle-invasive or locally advanced BCs (62%) and presented lymph node metastases (55%), resulting in a poor mean overall survival of 30.9 ± 3.6 months. No significant differences regarding histopathology, tumor stage, and oncological outcome could be observed between the groups. CONCLUSION Patients with NBDs have a poor prognosis regardless of their etiology or the level of NS lesion. Patients with spinal cord lesions, including congenital NBDs, appear to develop BC at a young age, but compared to other etiologies latency from NBD to BC is longer.
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Affiliation(s)
- Julia Mühlbauer
- Department of Urology and Urological Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - David Klotz
- Department of Urology and Urological Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Sylvia Büttner
- Department for Biomathematics and Medical Statistics, Faculty of Medicine Mannheim of the University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Raimund Stein
- Center for Pediatric, Adolescent and Reconstructive Urology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Nina Younsi
- Center for Pediatric, Adolescent and Reconstructive Urology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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15
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Zhao R, Guo X, Wang Y, Song Y, Su Q, Sun H, Liang M, Xue Y. Functional MRI evidence for primary motor cortex plasticity contributes to the disease's severity and prognosis of cervical spondylotic myelopathy patients. Eur Radiol 2022; 32:3693-3704. [PMID: 35029735 DOI: 10.1007/s00330-021-08488-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 10/30/2021] [Accepted: 11/28/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the brain mechanism of non-correspondence between diseases severity and compression degree of the spinal cord in cervical spondylotic myelopathy (CSM) patients and to test the utility of brain imaging biomarkers for predicting prognosis of CSM. METHODS We calculated voxel-wise zALFF from 54 CSM patients and 50 healthy controls using resting-state fMRI data. In analysis 1, we identified the brain regions exhibited significant differences of zALFF between CSM patients and healthy controls. In analyses 2 through 3, we investigated the zALFF differences between light-symptom CSM patients and severe-symptom CSM patients while carefully matching the degree of compression between these two groups. In analysis 4, we tested the utility of zALFF within the primary motor cortex (M1) for predicting the prognosis of CSM. RESULTS We found that (1) compared with the healthy controls, CSM patients exhibited higher ALFF within left M1, bilateral superior frontal gyrus, and lower zALFF within right precuneus and calcarine, suggesting altered brain neural activity in CSM patients; (2) after matching the compression degree, the CSM patients with more severe clinical symptoms exhibited higher zALFF within M1, indicating cortical function contributes to disease's severity of CSM; (3) taking the M1 zALFF as features in the prognosis prediction model improves the prediction accuracy, indicating that the M1 zALFF provide additional value for predicting the prognosis of CSM patients following decompression surgery. CONCLUSION The functional state of M1 contributes to the disease's severity of CSM and can provide complementary information for predicting the prognosis of CSM following decompression surgery. KEY POINTS • Cervical spondylotic myelopathy (CSM) patients exhibited increased zALFF within the primary motor cortex (M1), bilateral superior frontal gyrus, and decreased zALFF within the right precuneus and calcarine. • After matching the compression degree, the CSM patients with more severe clinical symptoms exhibited higher zALFF within M1, indicating cortical function contributes to disease severity of CSM. • zALFF within M1 provided additional value for predicting the prognosis of CSM patients.
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Affiliation(s)
- Rui Zhao
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Xing Guo
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Yang Wang
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - YingChao Song
- School of Medical Imaging, Tianjin Medical University and Tianjin Key Laboratory of Functional Imaging, Tianjin, 300203, China
| | - Qian Su
- Department of Molecular Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for China, Tianjin, 300060, China
| | - HaoRan Sun
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Meng Liang
- School of Medical Imaging, Tianjin Medical University and Tianjin Key Laboratory of Functional Imaging, Tianjin, 300203, China.
- Department of Molecular Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for China, Tianjin, 300060, China.
| | - Yuan Xue
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, 300052, China.
- School of Medical Imaging, Tianjin Medical University, Tianjin, 300070, China.
- Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin Medical University General Hospital, Tianjin, 300052, China.
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16
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Zhang MZ, Ou-Yang HQ, Liu JF, Jin D, Wang CJ, Ni M, Liu XG, Lang N, Jiang L, Yuan HS. Predicting postoperative recovery in cervical spondylotic myelopathy: construction and interpretation of T 2*-weighted radiomic-based extra trees models. Eur Radiol 2022; 32:3565-3575. [PMID: 35024949 DOI: 10.1007/s00330-021-08383-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/21/2021] [Accepted: 10/04/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Conventional MRI may not be ideal for predicting cervical spondylotic myelopathy (CSM) prognosis. In this study, we used radiomics in predicting postoperative recovery in CSM. We aimed to develop and validate radiomic feature-based extra trees models. METHODS There were 151 patients with CSM who underwent preoperative T2-/ T2*-weighted imaging (WI) and surgery. They were divided into good/poor outcome groups based on the recovery rate. Datasets from multiple scanners were randomised into training and internal validation sets, while the dataset from an independent scanner was used for external validation. Radiomic features were extracted from the transverse spinal cord at the maximum compressed level. Threshold selection algorithm, collinearity removal, and tree-based feature selection were applied sequentially in the training set to obtain the optimal radiomic features. The classification of intramedullary increased signal on T2/T2*WI and compression ratio of the spinal cord on T2*WI were selected as the conventional MRI features. Clinical features were age, preoperative mJOA, and symptom duration. Four models were constructed: radiological, radiomic, clinical-radiological, and clinical-radiomic. An AUC significantly > 0.5 was considered meaningful predictive performance based on the DeLong test. The mean decrease in impurity was used to measure feature importance. p < 0.05 was considered statistically significant. RESULTS On internal and external validations, AUCs of the radiomic and clinical-radiomic models, and radiological and clinical-radiological models ranged from 0.71 to 0.81 (significantly > 0.5) and 0.40 to 0.55, respectively. Wavelet-LL first-order variance was the most important feature in the radiomic model. CONCLUSION Radiomic features, especially wavelet-LL first-order variance, contribute to meaningful predictive models for CSM prognosis. KEY POINTS • Conventional MRI features may not be ideal in predicting prognosis. • Radiomics provides greater predictive efficiency in the recovery from cervical spondylotic myelopathy.
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Affiliation(s)
- Meng-Ze Zhang
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
| | - Han-Qiang Ou-Yang
- Department of Orthopedics, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Jian-Fang Liu
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
| | - Dan Jin
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
| | - Chun-Jie Wang
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
| | - Ming Ni
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
| | - Xiao-Guang Liu
- Department of Orthopedics, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Ning Lang
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
| | - Liang Jiang
- Department of Orthopedics, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China.
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China.
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China.
| | - Hui-Shu Yuan
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China.
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17
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Pereira RG, Ribeiro BNDF, Pereira TRGC, Bahia PRV, Marchiori E. Magnetic resonance imaging evaluation of spinal cord lesions: what can we find? - Part 2. Inflammatory and infectious injuries. Radiol Bras 2021; 54:412-417. [PMID: 34866702 PMCID: PMC8630953 DOI: 10.1590/0100-3984.2020.0128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/27/2020] [Indexed: 11/22/2022] Open
Abstract
Diseases involving the spinal cord include a heterogeneous group of abnormalities, including those of inflammatory, infectious, neoplastic, vascular, metabolic, and traumatic origin. Making the clinical differentiation between different entities is often difficult, magnetic resonance imaging being the diagnostic method of choice. Although the neuroimaging findings are not pathognomonic, many are quite suggestive, and the radiologist can assist in the diagnosis and, consequently, in the therapeutic guidance. In this second part of our article, the objective is to review the magnetic resonance imaging findings of the main inflammatory and infectious spinal cord injuries.
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Affiliation(s)
- Ronaldo Gonçalves Pereira
- Hospital Casa de Portugal / 3D Diagnóstico por Imagem, Rio de Janeiro, RJ, Brazil.,Grupo Labs Fleury/RJ, Rio de Janeiro, RJ, Brazil
| | - Bruno Niemeyer de Freitas Ribeiro
- Hospital Casa de Portugal / 3D Diagnóstico por Imagem, Rio de Janeiro, RJ, Brazil.,Grupo Labs Fleury/RJ, Rio de Janeiro, RJ, Brazil.,Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, RJ, Brazil
| | | | - Paulo Roberto Valle Bahia
- Grupo Labs Fleury/RJ, Rio de Janeiro, RJ, Brazil.,Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Edson Marchiori
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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18
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de Souza Batista AV, de Aguiar GB, Bennett P, Veiga JCE. Periodontoid pseudotumoral lesions. Surg Neurol Int 2021; 12:403. [PMID: 34513169 PMCID: PMC8422533 DOI: 10.25259/sni_588_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 07/07/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Periodontoid pseudotumoral lesions (PPL) are an uncommon cause of cervical pain and myelopathy. In addition, they may be associated with atlantoaxial instability (AAI). Case Description: Two patients over 60 years of age presented with neck pain alone. Their MR scans showed expansive lesions involving the odontoid process. One patient with AAI required an occipitocervical arthrodesis, while the other patient without instability was managed with an external orthosis (Philadelphia collar). Both of them experienced full resolution of pain and remained neurologically intact an average 36 months later (range 24–48). Conclusion: Here, we discussed the clinical, MR, and non-surgical (without AAI) versus surgical management (with AAI) for different types of PPL.
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Affiliation(s)
| | | | - Priscilla Bennett
- Department of Surgery, Santa Casa de Sao Paulo School of Medical Sciences, São Paulo, Brazil
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19
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Pucci GF, Akita J, Berkowitz AL. Clinical-Radiologic Dissociation in Post-traumatic Syringomyelia. World Neurosurg 2021; 153:9-10. [PMID: 34153481 DOI: 10.1016/j.wneu.2021.06.063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 01/12/2023]
Abstract
Post-traumatic syringomyelia develops years to decades after spinal trauma in up to 28% of patients. We report a case of a man who developed extensive syringomyelia 14 years after spinal trauma, but had only minimal symptoms. Presumed pathophysiology of this condition and options for surgical management are briefly reviewed.
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Affiliation(s)
- Gabriela F Pucci
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School of Sao Paulo State University (UNESP), Sao Paulo, Brazil.
| | - Juliana Akita
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School of Sao Paulo State University (UNESP), Sao Paulo, Brazil
| | - Aaron L Berkowitz
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
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20
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Rigot SK, DiGiovine KM, Boninger ML, Hibbs R, Smith I, Worobey LA. Effectiveness of a Web-Based Direct-to-User Transfer Training Program: A Randomized Controlled Trial. Arch Phys Med Rehabil 2021; 103:807-815.e1. [PMID: 34090854 DOI: 10.1016/j.apmr.2021.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/19/2021] [Accepted: 05/21/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To determine the effectiveness of a web-based, direct-to-user transfer training program in improving transfer quality and maintaining improvements for up to 1 month after training as compared with a control group. DESIGN Randomized controlled trial with participants randomized to an immediate intervention group (IIG) or waitlist control group (WLCG) that received the training after a 6-month delay. SETTING Wherever the participants accessed the web-based training, likely the home environment. PARTICIPANTS Convenience sample of full-time wheelchair users (N=72; IIG, n=34; WLCG, n=38 for between-group analysis, n=48 for combined within-group analysis) with spinal cord injury or disorder who were able to independently perform a lateral scoot transfer. INTERVENTIONS Self-paced, web-based transfer training module. MAIN OUTCOME MEASURES Transfer Assessment Instrument Questionnaire (TAI-Q) score at baseline, 1 month, and 6 months postbaseline (WLCG only), immediately posttraining, and 1 month posttraining. The TAI-Q is an 18-item self-assessment that covers several aspects of a quality transfer. RESULTS The IIG significantly increased particpants' baseline TAI-Q score from 6.91±0.98 to 7.79±1.12 (P<.001) by 1 month posttraining. The WLCG also increased from baseline to the 1-month postbaseline assessment (from 6.52±1.13 to 7.00±1.09; P=.014), potentially from learning effects secondary to self-assessment with the TAI-Q. The extent of change over time did not differ significantly between the IIG and WLCG from baseline to 1 month (P=.169). However, significant improvements in TAI-Q scores were still evident after the training for the WLCG (P<.001). Those with a lower pretraining TAI-Q score and more shoulder pain were most likely to benefit from the training. CONCLUSIONS Repeated TAI-Q self-assessments likely contributed to improved transfer quality, with web-based training having an additive effect. Wheelchair users are likely to benefit from transfer training and self-assessment of transfer quality in their home environments. This has the potential to decrease injury risk while avoiding barriers to in-person training.
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Affiliation(s)
- Stephanie K Rigot
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA; Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
| | - Kaitlin M DiGiovine
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA; Department of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Michael L Boninger
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA; Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA; Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA; Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
| | - Rachel Hibbs
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA; Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
| | - Ian Smith
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA; Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
| | - Lynn A Worobey
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA; Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA; Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA; Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA.
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21
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Gharooni AA, Khan M, Yang X, Anwar F, Davies B, Kotter M. Therapeutic repetitive Transcranial Magnetic stimulation (rTMS) for neurological dysfunction in Degenerative cervical Myelopathy: An unexplored opportunity? Findings from a systematic review. J Clin Neurosci 2021; 90:76-81. [PMID: 34275584 DOI: 10.1016/j.jocn.2021.05.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/10/2021] [Indexed: 01/18/2023]
Abstract
Degenerative Cervical Myelopathy (DCM) is one of the commonest causes of non-traumatic Spinal Cord Injury (SCI) leading to significant neurological impairments and reduced health-related quality of life. Guidelines recommend surgical intervention to halt disease progression in moderate-to-severe cases, and whilst many do experience neurological recovery, this is incomplete leading to lifelong disability. A James Lind Alliance (JLA) research priority setting partnership for DCM highlighted novel therapies and rehabilitation as top 10 research priority in DCM. Neurological recovery following decompressive surgery in DCM has been attributed neuroplasticity, and therapies influencing neuroplasticity are of interest. Electrical neuromodulation interventions such as repetitive Transcranial Magnetic Stimulation (rTMS), are being increasingly explored in related fields such as spinal cord injury to improve recovery and symptoms. The aim of this systematic review was to determine the role and efficacy of rTMS as a therapeutic tool in managing neurological dysfunction in DCM. We searched the databases of Medline, EMBASE, CINAHIL and Cochrane Central Register of Controlled Trials (CENTRAL). No studies were identified that had investigated the therapeutic use of rTMS in DCM. A significant number of studies had explored TMS based neurophysiological assessments indicating its role as a screening and prognostication tool in DCM. Post-operative rehabilitation interventions including TMS and non-operative management of DCM is a field which requires further investigation, as required in the AO Spine JLA DCM research priorities. rTMS is a safe neuromodulatory intervention and may have a role in enhancing recovery in DCM. Further research in these fields are required.
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22
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Brown NJ, Lien BV, Shahrestani S, Choi EH, Tran K, Gattas S, Ransom SC, Tafreshi AR, Ransom RC, Sahyouni R, Chan A, Oh M. Getting Down to the Bare Bones: Does laminoplasty or laminectomy With Fusion Provide Better Outcomes for Patients With Multilevel Cervical Spondylotic Myelopathy? Neurospine 2021; 18:45-54. [PMID: 33819935 PMCID: PMC8021836 DOI: 10.14245/ns.2040520.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/27/2020] [Indexed: 11/19/2022] Open
Abstract
Objective Cervical spondylotic myelopathy (CSM) is a degenerative disorder leading to progressive decline in spinal cord function. Cervical laminoplasty (CLP) and cervical laminectomy with fusion (CLF) are standard treatments for multilevel CSM. However, it is still unclear whether one procedure over the other provides better outcomes. Here, we performed a comprehensive review of published articles that compare the clinical outcomes and costs between CLP and CLF for CSM.
Methods A literature search was performed using PubMed, Web of Science, and Cochrane databases. Strict exclusion criteria were applied, and included articles were then assessed for publication year, study design, and significant differences in outcome variables.
Results From 519 studies identified with search terms, 38 studies were included for the qualitative analysis. Statistically significant differences in the clinical outcomes and costs were found in 18 studies. Eleven studies were prospective or retrospective, and 8 studies were meta-analyses. For the outcome variables of interest, results were reported by classifying into prospective studies, retrospective studies, and meta-analyses.
Conclusion CLP and CLF are 2 of the most commonly performed surgical procedures for the treatment of CSM. Although CLP and CLF each provide satisfactory clinical outcomes for patients with CMS, CLP may result in better cervical range of motion and less cost, length of stay, operation time, blood loss, paraspinal muscular atrophy, and rate of nerve palsies as compared to CLF. The major limitation of CLP versus CLF comparison studies includes the heterogeneity in techniques and preoperative criteria. Thus, further validation and investigations in larger cohorts will be required.
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Affiliation(s)
- Nolan J Brown
- School of Medicine, University of California, Irvine, Irvine, CA, USA
| | - Brian V Lien
- School of Medicine, University of California, Irvine, Irvine, CA, USA
| | - Shane Shahrestani
- Keck School of Medicine of USC, Los Angeles, CA, USA.,Medical Scientist Training Program, California Institute of Technology, Pasadena, CA, USA
| | - Elliot H Choi
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Katelynn Tran
- University of Southern California, Los Angeles, CA, USA
| | - Sandra Gattas
- School of Medicine, University of California, Irvine, Irvine, CA, USA
| | - Seth C Ransom
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ali R Tafreshi
- Department of Neurological Surgery, Geisinger Health System, Danville, Pennsylvania, PA, USA
| | - Ryan Chase Ransom
- Department of Neurologic Surgery, Mayo Clinic Alix School of Medicine, Rochester, MN, USA
| | - Ronald Sahyouni
- Department of Neurological Surgery, University of California, San Diego, La Jolla, CA, USA
| | - Alvin Chan
- Department of Neurological Surgery, University of California, Irvine, Orange, CA, USA
| | - Michael Oh
- Department of Neurological Surgery, University of California, Irvine, Orange, CA, USA
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23
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Kettner M, Udelhoven A. [Nonneoplastic lesions of the spinal canal]. Radiologe 2021; 61:283-90. [PMID: 33566131 DOI: 10.1007/s00117-021-00829-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2021] [Indexed: 10/22/2022]
Abstract
Numerous vascular, inflammatory, degenerative and tumorous lesions of the spinal canal can cause paraplegic symptoms. In addition to the neurological examination and the leading symptoms, the first topographical classification of the (suspected) disease is essential for further diagnostics. Hence, high-resolution magnet resonance imaging (MRI) is the gold standard for the majority of questions. To avoid diagnostic and therapeutic mistakes, differentiation of intraspinal tumors from tumor-like (nonneoplastic) lesions is indispensable, which is often only possible after follow-up imaging or surgical exploration.
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24
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Freitas Filho LG, Carvalho da Fonseca AC, Magalhães RM, Guerreiro Paiva TR, Coelho G, Gomes Abreu MC. Spinal cord tumor leading to urinary retention resulting from Schistosoma mansoni infection in a child. Urol Case Rep 2020; 34:101479. [PMID: 33209586 PMCID: PMC7658661 DOI: 10.1016/j.eucr.2020.101479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/26/2020] [Accepted: 11/01/2020] [Indexed: 11/16/2022] Open
Abstract
Schistosomose mansoni is an endemic disease in Brazil. It rarely affects the central nervous system, particularly in children. We report the case of a child that presented with an acute spinal cord compression condition, resulting from a mass that proved to be a granuloma caused by a Schistosoma mansoni infection. Proper treatment had no effect on the regression of urological symptoms and the child had to undergo a Mitrofanoff principle.
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Affiliation(s)
- Luiz G Freitas Filho
- Department of Urology, Universidade Federal de São Paulo, Brazil.,Department of Pediatric Surgery, Hospital Santa Marcelina, Brazil
| | | | | | | | - Giselle Coelho
- Department of Neurosurgery, Hospital Santa Marcelina, Brazil
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25
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Ertzgaard P, Nene A, Kiekens C, Burns AS. A review and evaluation of patient-reported outcome measures for spasticity in persons with spinal cord damage: Recommendations from the Ability Network - an international initiative. J Spinal Cord Med 2020; 43:813-823. [PMID: 30758270 PMCID: PMC7808317 DOI: 10.1080/10790268.2019.1575533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Context: Patient-reported outcome measures (PROMs) are valuable for capturing the impact of spasticity on health-related quality of life (HRQoL) in persons with spinal cord damage (SCD) and evaluating the efficacy of interventions. Objective: To provide practical guidance for measuring HRQoL in persons with spasticity following SCD. Methods: Literature reviews identified measures of HRQoL and caregiver burden, utilized in studies addressing spasticity in SCD. Identified measures were evaluated for clinical relevance and practicality for use in clinical practice and research. The PRISM, SCI-SET, EQ-5D and SF-36 instruments were mapped to the International Classification of Functioning, Disability and Health (ICF). The PRISM and SCI-SET were evaluated using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. Results: Two spasticity-specific, five generic, and four preference-based measures were identified. ICF mapping and the COSMIN checklist supported the use of the PRISM and SCI-SET in SCD. The SF-36 is considered the most useful generic measure; disability-adapted versions may be more acceptable but further studies on psychometric properties are required. The SF-36 can be converted to a preference-based measure (SF-6D), or alternatively the EQ-5D can be used. While no measures specific to caregivers of people with SCD were identified, the Caregiver Burden Scale and the Zarit Burden Interview are considered suitable. Conclusion: Recommended measures include the PRISM and SCI-SET (condition-specific), SF-36 (generic), and Caregiver Burden Scale and Zarit Burden Interview (caregiver burden). Consideration should be given to using condition-specific and generic measures in combination; the PRISM or SCI-SET combined with SF-36 is recommended.
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Affiliation(s)
- Per Ertzgaard
- Rehabiliteringsmedicinska Kliniken, University Hospital, Linköping, Sweden,Correspondence to: Per Ertzgaard Rehabiliteringsmedicinska Kliniken, University Hospital, SE-582 85, Linköping, Sweden; phone +46 707955853. E-mail:
| | - Anand Nene
- Formerly, Roessingh Centre for Rehabilitation, Roessingh Research & Development, Enschede, The Netherlands
| | - Carlotte Kiekens
- Department of Development and Regeneration, KU Leuven – University of Leuven, Leuven, Belgium,Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Anthony S. Burns
- Division of Physiatry, Division of Medicine, University of Toronto, Toronto, Canada
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Paul AJ, Amritanand R, Margabandhu P, Karuppusami R, David KS, Krishnan V. Composite Grip Strength as a Marker of Outcome in Patients Surgically Treated for Degenerative Cervical Myelopathy. Asian Spine J 2020; 15:664-672. [PMID: 33108846 PMCID: PMC8561153 DOI: 10.31616/asj.2020.0253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 06/28/2020] [Indexed: 11/23/2022] Open
Abstract
Study Design Retrospective case series. Purpose This study aimed to examine the efficacy of composite grip strength as a marker of surgical outcome in patients with moderate to severe degenerative cervical myelopathy. Overview of Literature Degenerative cervical myelopathy causes loss of dexterity, muscle strength, and sensations in the hand. The impact of surgical management on improvement in composite grip strength has received scant attention. Methods This retrospective study was performed on degenerative cervical myelopathy patients with a complete composite grip strength assessment between January 2013 to January 2019. The Biometrics E-link hand kit was used for the assessment. The following parameters were measured: maximum grip strength, sustained grip strength, three-jaw pinch, maximum key pinch, and sustained key pinch. The pre- and postoperative functional status was assessed using the Nurick grade and the modified Japanese Orthopaedic Association (mJOA) score. Results A total of 40 patients were included in the study. The mean patient age was 51.9 years. The mean preoperative Nurick grade was 3.5 and the mJOA score was 10.9. The anterior approach was used in 25 patients, and the posterior approach was used in 15 patients. Four patients developed complications. Degenerative cervical myelopathy resulted in decreased handgrip and pinch strength as compared to normative Indian data. There was a significant improvement in the postoperative composite grip strength for all five parameters. There was no differential improvement between the anterior and posterior surgical groups. The improvement in the composite grip strength correlated with the improvement in functional scores. Conclusions Composite grip strength analysis is an objective method for assessing the impact of degenerative cervical myelopathy on grip strength and monitoring the postoperative improvement. Decompressive surgery resulted in global improvement in all the parameters of composite grip strength.
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Affiliation(s)
- Arun John Paul
- Spinal Disorders Surgery Unit, Department of Orthopaedics, Christian Medical College, Vellore, India
| | - Rohit Amritanand
- Spinal Disorders Surgery Unit, Department of Orthopaedics, Christian Medical College, Vellore, India
| | | | - Reka Karuppusami
- Department of Biostatistics, Christian Medical College, Vellore, India
| | - Kenny Samuel David
- Spinal Disorders Surgery Unit, Department of Orthopaedics, Christian Medical College, Vellore, India
| | - Venkatesh Krishnan
- Spinal Disorders Surgery Unit, Department of Orthopaedics, Christian Medical College, Vellore, India
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Gaojian T, Dingfei Q, Linwei L, Xiaowei W, Zheng Z, Wei L, Tong Z, Benxiang N, Yanning Q, Wei Z, Jian C. Parthenolide promotes the repair of spinal cord injury by modulating M1/M2 polarization via the NF-κB and STAT 1/3 signaling pathway. Cell Death Discov 2020; 6:97. [PMID: 33083018 PMCID: PMC7538575 DOI: 10.1038/s41420-020-00333-8] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 09/11/2020] [Indexed: 12/11/2022] Open
Abstract
Spinal cord injury (SCI) is a severe neurological disease; however, there is no effective treatment for spinal cord injury. Neuroinflammation involves the activation of resident microglia and the infiltration of macrophages is the major pathogenesis of SCI secondary injury and considered to be the therapeutic target of SCI. Parthenolide (PN) has been reported to exert anti-inflammatory effects in fever, migraines, arthritis, and superficial inflammation; however, the role of PN in SCI therapeutics has not been clarified. In this study, we showed that PN could improve the functional recovery of spinal cord in mice as revealed by increased BMS scores and decreased cavity of spinal cord injury in vivo. Immunofluorescence staining experiments confirmed that PN could promote axonal regeneration, increase myelin reconstitution, reduce chondroitin sulfate formation, inhibit scar hyperplasia, suppress the activation of A1 neurotoxic reactive astrocytes and facilitate shift from M1 to M2 polarization of microglia/macrophages. To verify how PN exerts its effects on microglia/macrophages polarization, we performed the mechanism study in vitro in microglia cell line BV-2. PN could significantly reduce M1 polarization in BV2 cells and partially rescue the decrease in the expression of M2 phenotype markers of microglia/macrophage induced by LPS, but no significant effect on M2 polarization stimulated with IL-4 was observed. Further study demonstrated PN inhibited NF-κB signal pathway directly or indirectly, and suppressed activation of signal transducer and activator of transcription 1 or 3 (STAT1/3) via reducing the expression of HDAC1 and subsequently increasing the levels of STAT1/3 acetylation. Overall, our study illustrated that PN may be a promising strategy for traumatic SCI.
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Affiliation(s)
- Tao Gaojian
- Department of Anesthesiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029 China
- Department of Pain Management, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008 China
| | - Qian Dingfei
- Department of Orthopedic, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029 China
| | - Li Linwei
- Department of Orthopedic, The Third Affiliated Hospital of Soochow University, Changzhou, 213003 China
| | - Wang Xiaowei
- Department of Orthopedic, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029 China
| | - Zhou Zheng
- Department of Orthopedic, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029 China
| | - Liu Wei
- Department of Orthopedic, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029 China
| | - Zhu Tong
- Department of Pain Management, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008 China
| | - Ning Benxiang
- Department of Pain Management, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008 China
| | - Qian Yanning
- Department of Anesthesiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029 China
| | - Zhou Wei
- Department of Orthopedic, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029 China
| | - Chen Jian
- Department of Orthopedic, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029 China
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Alam M, Shufflebarger HL, Rush AJ, Rosas S, Lavelle WF, Sponseller PD, Asghar J. Delayed quadriparesis after posterior spinal fusion for scoliosis: a case series. Spine Deform 2020; 8:1075-80. [PMID: 32274769 DOI: 10.1007/s43390-020-00113-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 03/29/2020] [Indexed: 10/24/2022]
Abstract
STUDY DESIGN A multicenter retrospective IRB exempt case series analyzing clinical and radiographical data of patients treated by three surgeons over the past two decades was conducted. OBJECTIVE To examine the factors involved in the development of quadriparesis in patients who underwent posterior spinal fusion for scoliosis. Delayed spinal cord infarcts usually present at the region of instrumentation according to reports from the Scoliosis Research Society. Nonetheless, there is a lack of data regarding factors associated with delayed quadriparesis following posterior spinal fusion METHODS: Evaluated variables were age, Cobb angle, blood loss, and curve correction percentage. Postoperative imaging was also evaluated to determine factors indicative of the etiology of the quadriparesis. RESULTS Eight patients presented delayed postoperative quadriparesis. All patients had a postoperative examination equal to that of baseline. The first patient deteriorated at 6 h postoperatively and the most delayed patient presented 4 days postoperatively. Six patients had neuromuscular disorders and 2 had adolescent idiopathic scoliosis. Mean age was 13.7, mean curve magnitude was 78.7°, mean percent curve correction was 71% and the mean estimated blood loss was 1185 cc. Seven of eight patients had documented peri- or postoperative hypotension. CONCLUSIONS Cervical infarction is the likely cause of delayed quadriparesis after posterior spinal fusion. Even though the underlying etiology continues to be unclear, postoperative hypotension, curve magnitude, percent curve correction, and the presence of cervical kyphosis/stenosis may be contributory and need to be closely evaluated. LEVEL OF EVIDENCE IV, Case Series.
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de Miranda Henriques-Souza AM, de Melo ACMG, de Aguiar Coelho Silva Madeiro B, Freitas LF, Sampaio Rocha-Filho PA, Gonçalves FG. Acute disseminated encephalomyelitis in a COVID-19 pediatric patient. Neuroradiology 2021; 63:141-5. [PMID: 33001220 DOI: 10.1007/s00234-020-02571-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/23/2020] [Indexed: 01/14/2023]
Abstract
The authors present a case of acute disseminated encephalomyelitis in a COVID-19 pediatric patient with positive SARS-CoV2 markers from a nasopharyngeal swab. A previously healthy 12-year-old-girl presented with a skin rash, headache, and fever. Five days after that, she had an acute, progressive, bilateral, and symmetrical motor weakness. She evolved to respiratory failure. Magnetic resonance imaging (MRI) of the brain and cervical spine showed extensive bilateral and symmetric restricted diffusion involving the subcortical and deep white matter, a focal hyperintense T2/FLAIR lesion in the splenium of the corpus callosum with restricted diffusion, and extensive cervical myelopathy involving both white and gray matter. Follow-up examinations of the brain and spine were performed 30 days after the first MRI examination. The images of the brain demonstrated mild dilatation of the lateral ventricles and widespread widening of the cerebral sulci, complete resolution of the extensive white matter restricted diffusion, and complete resolution of the restricted diffusion in the lesion of the splenium of the corpus callosum, leaving behind a small gliotic focus. The follow-up examination of the spine demonstrated nearly complete resolution of the extensive signal changes in the spinal cord, leaving behind scattered signal changes in keeping with gliosis. She evolved with partial clinical and neurological improvement and was subsequently discharged.
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Niemi-Nikkola V, Koskinen E, Väärälä E, Kauppila AM, Kallinen M, Vainionpää A. Incidence of Acquired Nontraumatic Spinal Cord Injury in Finland: A 4-Year Prospective Multicenter Study. Arch Phys Med Rehabil 2020; 102:44-49. [PMID: 33007307 DOI: 10.1016/j.apmr.2020.08.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/05/2020] [Accepted: 08/25/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To evaluate the incidence and epidemiologic characteristics of acquired nontraumatic spinal cord injury (NTSCI) in Finland. DESIGN Prospective 4-year epidemiologic multicenter study. SETTING Two of the 3 spinal cord injury (SCI) centers in Finland responsible for acute care, immediate rehabilitation, and lifelong follow-up for all SCI patients in a population of 3,073,052 (as of 2013). PARTICIPANTS All newly diagnosed NTSCI patients (N=430) admitted to Tampere University Hospital between 2012 and 2015 and Oulu University Hospital between 2013 and 2016 based on the evaluation of the designated rehabilitation teams. Patients with NTSCI resulting from congenital etiologies or progressive neurologic diseases were excluded. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Incidence and variables, according to the International SCI Core Data Set and the International Standards for Neurological Classification of SCI, including etiology and the severity of injury. RESULTS The incidence of NTSCI was 54.1 per million per year. NTSCI was more common in men (n=260, 60.5%) than women (n=170, 39.5%). The mean age was 62.0±14.6 years old. Degenerative causes were the most common etiology (n=219, 50.9%), followed by malignant (n=88, 20.5%) and benign (n=41, 9.5%) neoplasms. The injury resulted in tetraplegia in 177 patients (41.1%) and paraplegia in 249 patients (57.9%). American Spinal Injury Association Impairment Scale grade D injuries were common, with an incidence of 71% (n=304). Specialized inpatient rehabilitation was needed in 44% (n=189) of the cases. CONCLUSIONS There are no previous studies on the epidemiology of NTSCI in Finland, and international reporting has been limited. The incidence of NTSCI in our study was substantially higher than in most previous studies, which was likely owing to our study including individuals with less severe lesions who did not require inpatient rehabilitation.
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Affiliation(s)
- Ville Niemi-Nikkola
- Oulu University Hospital, Department of Medical Rehabilitation, Oulu, Finland.
| | - Eerika Koskinen
- Tampere University Hospital, Department of Neurosciences and Rehabilitation, Tampere, Finland
| | - Eija Väärälä
- Tampere University Hospital, Department of Neurosciences and Rehabilitation, Tampere, Finland
| | - Anna-Maija Kauppila
- Oulu University Hospital, Department of Medical Rehabilitation, Oulu, Finland
| | - Mauri Kallinen
- Central Finland Central Hospital, Rehabilitation Department, Jyväskylä, Finland; The Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Aki Vainionpää
- Seinäjoki Central Hospital, Department of Rehabilitation, Seinäjoki, Finland
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Abstract
Objectives: There are few studies of sexual abuse in people with spinal cord damage (SCD). Objective of this study was to determine the prevalence and impact of sexual abuse in SCD. Design: Survey (web and paper-based). Setting: Australia (August 2013-June 2014). Participants: People with SCD (n = 136); able-bodied controls (n = 220). Interventions: None. Outcome measures: Spinal Cord Injury Secondary Conditions Scale, International SCI Quality of Life Basic Dataset, and the Physical Disability Sexual and Body Esteem scale. Questions regarding demographic and clinical characteristics, sex, sexual orientation, relationship status, disability, sexual interest and satisfaction, and sexual abuse. Results: Most SCD participants were male (n = 92, 67%), the average age was 46 years (SD = 14) and they were median of 11 years (IQR 4-21) after SCD. Of these, 19% (n = 26) reported sexual abuse. Females were much more likely to report being abused (odds ratio 3.3, 95%CI 1.5-7.4; χ2=10.9, P = 0.001). Participants reporting sexual abuse were younger (P = 0.01) and more likely to have been abused before their SCD (69%). There was no significant difference between those with SCD who reported sexual abuse and those who did not regarding their quality of life as a whole (P > 0.1). There was no difference regarding the reporting of sexual abuse between able-bodied and those with SCD (P = 0.1). Conclusion: Sexual abuse was relatively common and was not associated with an adverse relationship with the covariates assessed. Further research is needed to better determine the prevalence of sexual abuse in people with SCD and its impact.
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Leclerc A, Matveeff L, Emery E. Syringomyelia and hydromyelia: Current understanding and neurosurgical management. Rev Neurol (Paris) 2020; 177:498-507. [PMID: 32826067 DOI: 10.1016/j.neurol.2020.07.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Abstract
Syringomyelia is a rare disorder in which a fluid-filled cyst forms within the spinal cord, resulting in myelopathy. Meanwhile, the abnormal dilatation of the central canal is referred to as hydromyelia or slit-like syrinx. The most prevailing classification is based on anatomical features and pathogeny rather than pathophysiological mechanisms. It is usual to distinguish foraminal syringomyelia related mainly to abnormalities at the craniocervical junction, non-foraminal syringomyelia dealing with any cause of arachnoiditis (infection, inflammation, trauma…) and more rarely syringomyelia associated with intramedullary tumors. Although many pathophysiological theories have been argued over time, the prevailing one is that disturbances in cerebrospinal fluid (CSF) flow in the sub-arachnoid spaces disrupt flow velocity leading to the syrinx. Symptoms of paralysis, sensory loss and chronic pain commonly develop during the third/fourth decades of life. The natural history of syringomyelia is typically one of gradual, stepwise neurological deterioration extending over many years. Diagnosis is based on magnetic resonance imaging (MRI) including excellent morphological sequences (T1-, T2-, FLAIR-, T2*-, enhanced T1-) and dynamic MRI with careful study of CSF velocity (CISS, cine-MR sequences). Surgical management is at first dedicated to treat the cause of the syringomyelia, mainly to re-establish a physiological CSF pathway in the subarachnoid spaces. Mostly, the surgical goal is to enlarge the craniocervical junction with duraplasty. Other surgical strategies such as arachnoidolysis or shunt procedures are performed based on the pathogenic mechanisms or as second-line treatment. Medical treatments are also necessary as chronic pain is the main long-lasting symptom. As evolutive syringomyelia is a severe disease with a high impact on quality of life, it is recommended to treat without delay. There is no evidence for surgery for incidental asymptomatic syringomyelia or hydromyelia. Finally, syringomyelia associated with intramedullary tumors resolves spontaneously after tumor resection. Syringomyelia is a rare disease, which requires a dedicated multidisciplinary approach, emphasizing the need for a nationwide scientific organization so as to offer optimal care to the patient.
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Affiliation(s)
- A Leclerc
- CHU Caen, Department of Neurosurgery, Avenue de la Côte-de-Nacre, 14000 Caen, France; Université Caen Normandie, Medical School, 14000 Caen, France
| | - L Matveeff
- CHU Caen, Department of Neurosurgery, Avenue de la Côte-de-Nacre, 14000 Caen, France; Université Caen Normandie, Medical School, 14000 Caen, France
| | - E Emery
- CHU Caen, Department of Neurosurgery, Avenue de la Côte-de-Nacre, 14000 Caen, France; Université Caen Normandie, Medical School, 14000 Caen, France; INSERM, UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), GIP Cyceron, 14000 Caen, France.
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Pan Y, Ma X, Feng H, Chen C, Qin Z, Huang Y. Effect of posterior cervical expansive open-door laminoplasty on cervical sagittal balance. Eur Spine J 2020; 29:2831-7. [PMID: 32776264 DOI: 10.1007/s00586-020-06563-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 08/04/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Posterior cervical expansive open-door laminoplasty (LAMP) is a mature surgical procedure for the treatment of cervical spondylotic myelopathy (CSM), but there are few studies on the changes in cervical sagittal balance. This study aimed to analyze the imaging and clinical data of patients who underwent LAMP and to explore the effect of this procedure on the cervical sagittal balance. METHODS This was a retrospective study of the patients who underwent LAMP between 01/2014 and 12/2017. The C0-C2 Cobb angle, sagittal vertical angle (SVA), C2-C7 Cobb angle, and T1-slope were measured. The Japanese Orthopaedic Association (JOA) score, neck disability index (NDI), and visual analog scale (VAS) were used. RESULTS There were 69 males and 39 females. The mean age was 61.3 ± 5.3 years. The C0-C2 Cobb angle increased from 11.3 ± 5.5° to 26.8 ± 4.8° (P = 0.186). The C2-C7 Cobb angle decreased from 13.9 ± 8.6° to 10.65 ± 10.7° P = 0.016). SVA increased from 21.0 ± 5.8 mm to 25.4 ± 11.5 mm (P = 0.001). The preoperative average JOA score was 11.1 ± 2.2 points, and the postoperative score was 14.0 ± 2.1 points, with an average improvement rate of JOA of 46.5 ± 3.8%. The NDI score decreased from preoperative 15.6 ± 5.4 points to 11.3 ± 7.9 points, and the VAS score was decreased from 4.6 ± 1.8 points to 3.3 ± 1.6 points (all P < 0.05). CONCLUSION LAMP improved the neurological function and quality of life of patients with CSM. The cervical vertebrae show a tendency of tilting forward, suggesting that overextension of the upper cervical vertebra might be used to maintain the center of gravity of the skull and horizontal vision.
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Irie K, Iseki H, Okamoto K, Nishimura S, Kagechika K. Introduction of the Purdue Pegboard Test for fine assessment of severity of cervical myelopathy before and after surgery. J Phys Ther Sci 2020; 32:210-214. [PMID: 32184535 PMCID: PMC7064350 DOI: 10.1589/jpts.32.210] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 12/04/2019] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To evaluate the severity of symptoms before and after cervical myelopathy
surgery using the Simple Test for Evaluating hand Function. Because a test ceiling effect
was observed in patients with less severe forms of myelopathy, we investigated the
correlation between and accuracy of several different tests in order to clarify the
usefulness of the Purdue Pegboard Test for evaluation of one or both hands. [Participants
and Methods] Thirty-four patients (6 females and 28 males; mean age, 64.5 years) were
examined, and scores were determined for each of the following tests: Purdue Pegboard
Test; Simple Test for Evaluating hand Function; Japanese Orthopedic Association
assessment; and Disabilities of the Arm, Shoulder, and Hand assessment. Correlations
between scores of different tests were then determined. The cut-off values used for the
Purdue Pegboard Test and the Simple Test for Evaluating hand Function were determined
using the area under the receiver operating characteristic curve to assess the use of
chopsticks. [Results] The Purdue Pegboard Test assembly task correlated moderately with
the Japanese Orthopedic Association and Disabilities of the Arm, Shoulder, and Hand
scores. In the receiver operating characteristic curve analyses, the Purdue Pegboard Test
cut-off value was 11 and the Simple Test for Evaluating hand Function cut-off value was
90. [Conclusion] The Purdue Pegboard Test is useful for evaluating manual dexterity and
coordination in both hands in patients with cervical myelopathy.
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Affiliation(s)
- Keisuke Irie
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University: 53 Shogoin-kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto 606-8501, Japan
| | - Hirokatsu Iseki
- Department of Rehabilitation Medicine, Kanazawa Medical University Hospital, Japan
| | - Kazuhiro Okamoto
- Department of Rehabilitation Medicine, Kanazawa Medical University Hospital, Japan
| | - Seiji Nishimura
- Faculty of Health Science, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan
| | - Kenji Kagechika
- Toyama Prefectural Rehabilitation Hospital & Support Center for Children with Disabilities, Japan
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Kirshblum S, Eren F. Anal reflex versus bulbocavernosus reflex in evaluation of patients with spinal cord injury. Spinal Cord Ser Cases 2020; 6:2. [PMID: 31934354 PMCID: PMC6946655 DOI: 10.1038/s41394-019-0251-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/30/2019] [Accepted: 10/27/2019] [Indexed: 12/14/2022] Open
Abstract
The examination of sacral reflexes provides an important method to differentiate an upper motor neuron vs lower motor neuron spinal cord injury (SCI). Two common sacral mediated reflexes used as part of the neurological assessment include the bulbocavernosus reflex (BCR) and anal reflex. As the clinical information from these tests are similar, we suggest that the anal reflex provides a better first option as a non-invasive clinical assessment of sacral reflex status in clinical practice in SCI as the testing for the anal reflex is less intrusive and already being performed as part of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) by pinprick stimulation of the S4-5 dermatome.
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Affiliation(s)
- Steven Kirshblum
- Kessler Institution for Rehabilitation, West Orange, NJ USA
- 2Department of PM&R, Rutgers New Jersey Medical School, Newark, NJ USA
- 3Kessler Foundation, West Orange, NJ USA
| | - Fatma Eren
- 2Department of PM&R, Rutgers New Jersey Medical School, Newark, NJ USA
- 3Kessler Foundation, West Orange, NJ USA
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Santamaria V, Luna T, Khan M, Agrawal S. The robotic Trunk-Support-Trainer (TruST) to measure and increase postural workspace during sitting in people with spinal cord injury. Spinal Cord Ser Cases 2020; 6:1. [PMID: 31934353 PMCID: PMC6944685 DOI: 10.1038/s41394-019-0245-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 11/10/2019] [Accepted: 11/10/2019] [Indexed: 11/09/2022] Open
Abstract
Study design Cross-sectional study. Objectives To measure and expand the sitting workspace of participants with spinal cord injury (SCI) with the Trunk-Support-Trainer (TruST). Setting Columbia University. Methods TruST is a motorized-cable belt placed around the torso. Participants performed maximal trunk excursions along eight directions, radiating in a star-shape, to define their seated postural limits and workspace area (cm2). TruST was configured to apply "assist-as-needed" forces when the trunk moved beyond these postural limits. Kinematics were collected to examine trunk control. The clinical features of the sample (n = 5) were documented by neurological injury, dynamometry, the American Spinal Injury Association Impairment Scale, and Spinal Cord Independence Measure-III. Results Statistical significance was examined with paired t-tests. TruST successfully recreated the postural limits of participants and expanded their active sitting workspace (Mean: 123.3 ± SE: 42.8 cm2, p < 0.05). Furthermore, participants improved their trunk excursions to posterior (Mean: 5.1 ± SE: 0.8 cm, p < 0.01), right (Mean: 3.1 ± SE: 1.1 cm, p < 0.05), and left (Mean: 5.0 ± SE: 1.7 cm, p = 0.05) directions with TruST-force field. Conclusions TruST can accurately define and expand the active seated workspace of people with SCI during volitional trunk movements. The capacity of TruST to deliver continuous force-feedback at the user's postural limits opens new frontiers to implement motor learning-based paradigms to retrain functional sitting in people with SCI.
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Affiliation(s)
- Victor Santamaria
- Department of Mechanical Engineering, Columbia University, New York, NY 10027 USA
| | - Tatiana Luna
- Department of Mechanical Engineering, Columbia University, New York, NY 10027 USA
| | - Moiz Khan
- Department of Radiology at BWH, Harvard Medical School, Boston, MA 02115 USA
| | - Sunil Agrawal
- Department of Mechanical Engineering, Columbia University, New York, NY 10027 USA
- Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, NY 10032 USA
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Stillman MD, Williams S. Guideline for the identification and management of cardiometabolic risk after spinal cord injury: a case of unsubstantiated recommendations. Spinal Cord Ser Cases 2019; 5:97. [PMID: 31798972 PMCID: PMC6881404 DOI: 10.1038/s41394-019-0240-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/01/2019] [Accepted: 10/03/2019] [Indexed: 01/08/2023] Open
Abstract
The 2018 Guideline for the Identification and Management of Cardiometabolic Risk after Spinal Cord Injury (SCI) represented the first concerted effort to address a cluster of derangements and diseases that are claiming the lives of individuals living with injuries. Its contributors and authors scoured the literature, weighed the validity, importance, and clinical relevance of what data they found, and collaborated in an effort to meaningfully improve the health and lives of people with SCI. However, we are concerned that several of the guideline's central recommendations-particularly around screening for and detection of glycemic dysregulation and dyslipidemia-have been offered prematurely. In several instances, the authors cite data from studies of people without SCI and, in our opinion, inappropriately apply those findings to support their SCI-specific suggestions. In other instances, they recommend that we employ tests whose usefulness and clinical relevance have yet to be demonstrated among people living with injuries. In short, we fear that the authors have developed clinical guidelines that are inadequately supported by data. This guideline is an extraordinary show of collaboration, and is an important first step toward understanding and treating a number of secondary cardiometabolic effects of SCI. The lack of data underpinning several of its central recommendations-making them, in our opinion, unadoptable-underscores the inadequacy of research in this area and provides a roadmap for future investigative efforts.
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Affiliation(s)
- Michael D. Stillman
- Internal Medicine and Rehabilitation Medicine, Sydney Kimmel Medical College of Thomas Jefferson University, 1100 Walnut Street, Suite 601, Philadelphia, PA 19107 USA
| | - Steve Williams
- Rehabilitation Medicine, Sydney Kimmel Medical College, Philadelphia, PA USA
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Sabharwal S. Addressing cardiometabolic risk in adults with spinal cord injury: acting now despite knowledge gaps. Spinal Cord Ser Cases 2019; 5:96. [PMID: 31798971 PMCID: PMC6881335 DOI: 10.1038/s41394-019-0241-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 10/25/2019] [Indexed: 12/14/2022] Open
Abstract
This perspective advocates for the adoption of recently published clinical practice guidelines on identifying and managing cardiometabolic risk after spinal cord injury (SCI). It makes the case for acting now, with the knowledge that we currently have, while continuing to address knowledge gaps with high-quality research studies in this area. Cardiovascular disease is a leading cause of death in people with SCI. Cardiometabolic disease (CMD) and risks are more likely to be overlooked after SCI. Unique SCI-related considerations impact both assessment and management of cardiometabolic risk. Risk factors and components of CMD including obesity, impaired glucose tolerance/insulin resistance, dyslipidemia, and hypertension should be evaluated and managed to optimize the cardiometabolic health of this population. While it would be optimal to base all care on high-quality evidence-based research, its absence should not be an excuse for inaction. Applying what is currently known and filling the research gaps with empirical recommendations based on clinical rationale and expert consensus is both appropriate and necessary till more definitive SCI-specific evidence becomes available.
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Affiliation(s)
- S. Sabharwal
- VA Boston Health Care System, Boston, MA USA
- Harvard Medical School, Boston, MA USA
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Repecki C, Sliwinski M, Harding L. Supporting the need for community exercise programs: a case study. Spinal Cord Ser Cases 2019; 5:95. [PMID: 31798970 PMCID: PMC6877531 DOI: 10.1038/s41394-019-0236-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 09/03/2019] [Accepted: 10/11/2019] [Indexed: 11/08/2022] Open
Abstract
Introduction Participation in exercise activities post spinal cord injury (SCI) can positively impact physical functioning and quality of life. Physically active individuals have improved functional performance compared with sedentary individuals with SCI. Consistent exercise interventions following SCI not only prompt neural recovery and offer myriad health benefits but they may also have persisting effects on functional abilities. Case presentation A 29-year-old male subject had a 15-year history of a C5-C6 AIS B SCI. The subject demonstrated improvements in the outcome measures and he reported enhanced ability to cough and to clear secretions, as well as an enhanced overall quality of life, after undergoing a 14-week course of Spinal Mobility training in combination with inspiratory muscle training (IMT). In addition to the Spinal Mobility training and IMT, he continued to partake in his normal exercise routine, which consisted of aerobic and strength training 3 days per week. Discussion This case reaffirms the benefits of consistent exercise training, in combination with IMT, for individuals with SCI. Community programs specifically targeted to individuals with SCI are needed. The subject's functional improvements demonstrate that incorporating Spinal Mobility training into a regular exercise routine may assist with functional gains in the chronic stage of SCI.
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Affiliation(s)
- Christopher Repecki
- Columbia University Medical Center, Program in Physical Therapy, New York, NY USA
| | - Martha Sliwinski
- Columbia University Medical Center, Program in Physical Therapy, New York, NY USA
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Enríquez-Ruano P, Navarro CE, Ariza-Varón M, Calderón-Castro ADP. Myelopathy secondary to human T-lymphotropic virus and Treponema pallidum infection: case report. Spinal Cord Ser Cases 2019; 5:93. [PMID: 31728207 PMCID: PMC6834617 DOI: 10.1038/s41394-019-0238-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 10/26/2019] [Accepted: 10/27/2019] [Indexed: 11/09/2022] Open
Abstract
Introduction The human T-lymphotropic virus has been associated with human disease, affecting CD4+ T, CD8+ T, and B lymphocytes. It can cause T-cell leukemia/lymphoma and HTLV-associated myelopathy. Case presentation A 31-year-old woman was admitted after 2 months of cramps, paraparesis, and fecal/urinary incontinence. She was diagnosed with neurosyphilis according to the cerebrospinal fluid analysis. Despite treatment with crystalline penicillin there was no recovery, and anti-HTLV-1/2 tests were positive; therefore, the diagnosis of HTLV-associated myelopathy was made. The patient rejected glucocorticoid treatment; baclofen and carbamazepine were used to treat spasticity and cramps, respectively. The patient has not had progression. Discussion HTLV-associated myelopathy is generated by an exaggerated inflammatory response in the central nervous system with clonal expansion of CD4+ T and CD8+ T lymphocytes. There is not a specific and useful treatment; glucocorticoids can reduce inflammation, but do not improve clinical functional outcomes. There is a high prevalence of syphilis and human T-lymphotropic virus co-infection in tropical countries; however, myelopathy as the first clinical manifestation is unusual. The treatment of neurosyphilis could reduce the inflammation into the central nervous system and could decrease the progression of sequelae. This is the first case of myelopathy secondary to viral and treponemal co-infection confirmed in Colombia.
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Affiliation(s)
- Pilar Enríquez-Ruano
- Unit of Clinical Neurology, Department of Medicine, School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
- Grupo de Investigación en Neurología de la Universidad Nacional de Colombia—NEURONAL, Bogotá, Colombia
| | - Cristian Eduardo Navarro
- Unit of Clinical Neurology, Department of Medicine, School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
- Grupo de Investigación en Neurología de la Universidad Nacional de Colombia—NEURONAL, Bogotá, Colombia
| | - Michael Ariza-Varón
- Unit of Clinical Neurology, Department of Medicine, School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
- Grupo de Investigación en Neurología de la Universidad Nacional de Colombia—NEURONAL, Bogotá, Colombia
| | - Andrea del Pilar Calderón-Castro
- Unit of Clinical Neurology, Department of Medicine, School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
- Grupo de Investigación en Neurología de la Universidad Nacional de Colombia—NEURONAL, Bogotá, Colombia
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Alexander M, Carr C, Alexander J, Chen Y, McLain A. Assessing the ability of the Sacral Autonomic Standards to document bladder and bowel function based upon the Asia Impairment Scale. Spinal Cord Ser Cases 2019; 5:85. [PMID: 31700683 PMCID: PMC6821794 DOI: 10.1038/s41394-019-0228-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 09/14/2019] [Accepted: 09/17/2019] [Indexed: 12/30/2022] Open
Abstract
Study design Retrospective review of data. Objective To determine if there is a relationship between the Asia Impairment Scale (AIS) and the bladder and bowel components of the International Standards to Document Remaining Autonomic Function after SCI (ISAFSCI). Setting University-Based Academic Rehabilitation Program. Methods Retrospective cross-sectional study assessing International Standards for Neurologic Classification After SCI (ISNCSCI) examination along with bladder and bowel components of the ISAFSCI. Results Subjects with AIS A injuries were statistically less likely to have history of bladder control and bowel control per investigator determination and bladder sensation via self-report versus patients categorized with AIS B injuries. Self-reported history of bowel sensation and control of voiding were more likely in subjects with C, D, or E injuries than with B injuries. Bowel and bladder control as determined by investigator and bladder and bowel sensation and control as self-reported were all statistically less likely in persons with AIS A injuries versus CDE. Conclusions This retrospective study provides initial data regarding components of the bladder and bowel sections of the sacral ISAFSCI and AIS. Further prospective research is needed to further characterize the relationship between retention of bladder and bowel sensation and function and the AIS. We suggest that incorporation of the sacral components of the ISAFSCI into the ISNCSCI may be beneficial to obtain further information about retention of sacral function with specific patterns of injury.
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Affiliation(s)
- Marca Alexander
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham School of Medicine, Birmingham, AL USA
| | - Conley Carr
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham School of Medicine, Birmingham, AL USA
| | | | - Yuying Chen
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham School of Medicine, Birmingham, AL USA
| | - Amie McLain
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham School of Medicine, Birmingham, AL USA
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Marinho-Buzelli AR, Barela AMF, Craven BC, Masani K, Rouhani H, Popovic MR, Verrier MC. Effects of water immersion on gait initiation: part II of a case series after incomplete spinal cord injury. Spinal Cord Ser Cases 2019; 5:84. [PMID: 31700682 PMCID: PMC6821750 DOI: 10.1038/s41394-019-0231-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 09/24/2019] [Accepted: 09/28/2019] [Indexed: 11/09/2022] Open
Abstract
Study design Case series. Objectives This case series describes how the aquatic environment influences gait initiation in terms of the center of pressure (COP) excursion, impulses, trunk acceleration, and perceptions of participants with incomplete spinal cord injury (iSCI). Setting Tertiary Rehabilitation Hospital, Ontario, Canada. Methods Five individuals with iSCI (four cervical injuries/one thoracic injury, AIS D) participated in the study. Baseline clinical balance was evaluated by Berg Balance Scale and Mini-Balance Evaluation System Test. Participants initiated gait on a waterproof force plate and walked ~4 steps, in water and on land. COP trajectories during anticipatory and execution phases, impulses, and trunk acceleration parameters were investigated. Perceptions of walking in both environments were obtained using an interview. Results COP trajectory was prominently longer when individuals stepped forward. A decrease in velocity of COP was observed predominantly in the AP direction during stepping. Non-normalized vertical impulses decreased as the AP impulses increased, in water compared to land. Upper to lower trunk acceleration ratios showed how water resistance influenced the lower trunk acceleration. Most of participants reported that walking in water was challenging, but safer than on land. Conclusions Participants with higher balance function seemed to have more pronounced changes in anticipatory and execution phases' duration, length and velocity of COP. A faster anticipatory phase and a slower execution phase were observed in water than on land. Participants walked in water using a different trunk control strategy than on land and reported no fear of falling when walking in water versus land.
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Affiliation(s)
| | - Ana Maria Forti Barela
- Institute of Physical Activity and Sport Sciences, Cruzeiro do Sul University, Sao Paulo, Brazil
| | - B. Catharine Craven
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, ON Canada
- Department of Medicine & Rehabilitation Sciences Institute, University of Toronto, Toronto, ON Canada
| | - Kei Masani
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, ON Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON Canada
| | - Hossein Rouhani
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB Canada
| | - Milos R. Popovic
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, ON Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON Canada
| | - Mary C. Verrier
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, ON Canada
- Department of Physical Therapy & Rehabilitation Sciences Institute, University of Toronto, Toronto, ON Canada
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Murphy AT, Kravtsov S, Sangeux M, Rawicki B, New PW. Utilizing three dimensional clinical gait analysis to optimize mobility outcomes in incomplete spinal cord damage. Gait Posture 2019; 74:53-59. [PMID: 31446333 DOI: 10.1016/j.gaitpost.2019.08.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 06/25/2019] [Accepted: 08/03/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Three-dimensional gait analysis (3DGA) has not previously been considered by consensus panels of spinal cord experts for use in studies of patients with spinal cord damage (SCD), yet it is frequently used in other neurological populations, such as stroke and cerebral palsy. RESEARCH QUESTION How does 3DGA impairment based reporting guide individualised clinical decision-making in people with incomplete SCD? METHODS Retrospective open cohort case series recruited 48 adults with incomplete SCD (traumatic or non-traumatic spinal cord dysfunction) referred to the Clinical Gait Analysis Service (CGAS), Melbourne, Australia. Three-dimensional gait data were used to identify gait impairments by the multidisciplinary clinical team. Gait patterns were classified using the plantarflexor-knee extension couple index and the Gait Profile Score (GPS). The reason for referral and the recommendations made post-3DGA were collated in decision trees to extrapolate the potential value of 3DGA in decision making for targeted intervention in this population. RESULTS Participants with SCD generally walked at a reduced gait speed. When grouped by neurological level, the tetraplegia group had a significantly lower GPS, but no specific gait patterns emerged. Participants were primarily referred to the CGAS to direct clinical intervention decisions. The most frequent recommendation following 3DGA was the prescription of an ankle foot orthosis and in some cases, the recommendation was incongruent with the referrer's proposed intervention. SIGNIFICANCE 3DGA can provide specific guidance in management plans for gait of patients with incomplete SCD and may help to avoid inappropriate or unnecessary interventions. This sample of patients referred to the CGAS demonstrates its clinical utility in guiding clinicians in their decision making to target individualised intervention.
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Affiliation(s)
- Anna T Murphy
- Clinical Gait Analysis Service, Kingston Centre, Monash Health, Cheltenham, VIC, 3192, Australia; Faculty of Medicine, Nursing and Allied Health Sciences, Monash University, VIC, 3800, Australia.
| | - Stella Kravtsov
- Clinical Gait Analysis Service, Kingston Centre, Monash Health, Cheltenham, VIC, 3192, Australia.
| | - Morgan Sangeux
- Biomech-Intel, Marseille, France; The Murdoch Children's Institute, Parkville, VIC, 3052, Australia; The University of Melbourne, Parkville, VIC, 3052, Australia
| | - Barry Rawicki
- Clinical Gait Analysis Service, Kingston Centre, Monash Health, Cheltenham, VIC, 3192, Australia; Faculty of Medicine, Nursing and Allied Health Sciences, Monash University, VIC, 3800, Australia.
| | - Peter W New
- Faculty of Medicine, Nursing and Allied Health Sciences, Monash University, VIC, 3800, Australia; Spinal Rehabilitation Service, Caulfield Hospital, Alfred Health, Caulfield, VIC, 3162, Australia; Rehabilitation and Aged Services Program, Department of Medicine, Monash Health, Cheltenham, VIC, 3192, Australia; Epworth-Monash Rehabilitation Medicine Unit, Monash University, VIC, 3800, Australia.
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Silver JR, Weiner MF. Urtication (flogging with stinging nettles) and flagellation (beating with rods) in the treatment of paralysis. Spinal Cord Ser Cases 2019; 5:79. [PMID: 31632737 PMCID: PMC6786426 DOI: 10.1038/s41394-019-0222-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/12/2019] [Accepted: 08/23/2019] [Indexed: 11/16/2022] Open
Abstract
Urtication and flagellation were used as a last resort in the treatment of paralysis when all other means were exhausted, and very few cases are reported in the literature. Two cases were identified and reviewed, one of urtication (flogging with nettles) and one of flagellation (beating with rods). In both cases the symptoms were alleviated, but there was insufficient detail to evaluate the therapeutic value of each treatment.
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Affiliation(s)
- J. R. Silver
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK
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Panza GS, Herrick JE, Chin LM, Gollie JM, Collins JP, O’Connell DG, Guccione AA. Effect of overground locomotor training on ventilatory kinetics and rate of perceived exertion in persons with cervical motor-incomplete spinal cord injury. Spinal Cord Ser Cases 2019; 5:80. [PMID: 31632738 PMCID: PMC6786384 DOI: 10.1038/s41394-019-0223-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/29/2019] [Accepted: 09/08/2019] [Indexed: 11/09/2022] Open
Abstract
Study design Pre-post, pilot study. Objectives To characterize ventilatory (VE) responses to exercise following warm-up walking in individuals with chronic incomplete spinal cord injury (iSCI) during constant work rate (CWR) exercise. Secondarily, to investigate VE and tidal volume (VT) variability, and ratings of perceived exertion (RPE) before and after overground locomotor training (OLT). Setting Research laboratory. Methods A 6-min CWR walking bout at preferred pace was used as a warm-up followed by 6 min of rest and a second 6-min CWR bout at above preferred walking pace. The second CWR bout was analyzed. Breath-by-breath ventilatory data were examined using a curvilinear least squares fitting procedure with a mono-exponential model. VE and VT variability was calculated as the difference between the observed and predicted values and RPE was taken every 2 min. Results Participants (n = 3, C4-C5) achieved a hyperpneic response to exercise in VE and VT. OLT resulted in faster ventilatory kinetics and reductions of 24 and 29% for VE and VT variability, respectively. A 30% reduction in RPE was concurrent with the reductions in ventilatory variability. Conclusions OLT may improve ventilatory control during CWR in patients with cervical motor-iSCI. These data suggest that in some participants with iSCI, ventilation may influence RPE during walking. Future research should investigate mechanisms of ventilatory variability and its implications in walking performance in patients with iSCI.
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Affiliation(s)
- Gino S. Panza
- John D. Dingell Veterans Affairs Medical Center, Detroit, MI USA
- Department of Physiology, Wayne State University School of Medicine, Detroit, MI USA
| | - Jeffrey E. Herrick
- Department of Exercise Physiology, University of Lynchburg, Lynchburg, VA USA
| | - Lisa M. Chin
- Rehabilitation Medicine Department, National Institutes of Health, Clinical Center, Bethesda, MD USA
| | | | | | | | - Andrew A. Guccione
- Department of Rehabilitation Science, George Mason University, Fairfax, VA USA
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Chun A, Levy I, Yang A, Delgado A, Tsai CY, Leung E, Taylor K, Kolakowsky-Hayner S, Huang V, Escalon M, Bryce TN. Treatment of at-level spinal cord injury pain with botulinum toxin A. Spinal Cord Ser Cases 2019; 5:77. [PMID: 31632735 PMCID: PMC6786298 DOI: 10.1038/s41394-019-0221-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 08/23/2019] [Accepted: 09/01/2019] [Indexed: 12/25/2022] Open
Abstract
Study design Randomized, double-blinded, placebo-controlled, cross-over study. Objective To explore whether botulinum toxin A (BoNTA) could be effective for treating at-level spinal cord injury (SCI) pain. Setting Outpatient SCI clinic, New York, USA. Methods Participants were randomized to receive subcutaneous injections of either placebo or BoNTA with follow-up (office visit, telephone, or e-mail) at 2, 4, 8, and 12 weeks to assess the magnitude of pain relief post injection. Crossover of participants was then performed. Those who received placebo received BoNTA, and vice versa, with follow-up at 2, 4, 8, and 12 weeks. Results Eight participants completed at least one of the two crossover study arms. Four completed both arms. The median age of the eight participants was 45 years (range 32-61 years) and 75% were male. All had traumatic, T1-L3 level, complete SCI. Although our data did not meet statistical significance, we noted a higher proportion of participants reporting a marked change in average pain intensity from baseline to 8 and 12 weeks post-BoNTA vs. post-placebo (33% vs. 0%). At 2 and 4 weeks post-BoNTA, almost all participants reported some degree of reduced pain, while the same was not seen post-placebo (83% vs. 0%). Conclusion The subcutaneous injection of BoNTA may be a feasible approach for the control of at-level SCI pain and is worthy of further study. Sponsorship The onabotulinumtoxinA (BOTOX) used in this study was provided by Allergan (Irvine, CA).
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Affiliation(s)
- Audrey Chun
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai (ISMMS), New York, NY USA
| | - Isaiah Levy
- Icahn School of Medicine at Mount Sinai (ISMMS), New York, NY USA
| | - Ajax Yang
- The Spine and Pain Institute of New York, New York, NY USA
| | - Andrew Delgado
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai (ISMMS), New York, NY USA
- Graduate School of Biomedical Sciences, ISMMS, New York, NY USA
| | - Chung-Ying Tsai
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai (ISMMS), New York, NY USA
| | - Eric Leung
- Department of Physical Medicine and Rehabilitation, Department of Pain Medicine, Northwell Health Physician Partners, Bay Shore, NY USA
| | - Kristell Taylor
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai (ISMMS), New York, NY USA
| | - Stephanie Kolakowsky-Hayner
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai (ISMMS), New York, NY USA
| | - Vincent Huang
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai (ISMMS), New York, NY USA
| | - Miguel Escalon
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai (ISMMS), New York, NY USA
| | - Thomas N. Bryce
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai (ISMMS), New York, NY USA
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Kuo YH, Kuo CH, Huang WC, Wu JC. Anterior Cervical Discectomy and Fusion for Hirayama Disease: A Case Report and Literature Review. Neurospine 2019; 16:626-630. [PMID: 30653906 PMCID: PMC6790718 DOI: 10.14245/ns.1836178.089] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 12/24/2018] [Accepted: 12/26/2018] [Indexed: 12/14/2022] Open
Abstract
Hirayama disease, a juvenile muscular atrophy of the distal upper extremity, is a rare form of cervical flexion myelopathy characterized by insidiously progressive weakness of the hands and forearm muscles (i.e., painless amyotrophy). The pathognomonic finding is a markedly forward-shifted spinal cord during neck flexion, demonstrated by dynamic magnetic resonance imaging (MRI), as in a young man with muscle atrophy in the bilateral distal upper extremities. In this report, the authors describe a 31-year-old man who had the classic radiological and clinical presentations of Hirayama disease. Since prior medical treatment had been ineffective for years, he underwent multilevel instrumented anterior cervical discectomy and fusion (ACDF) to keep his subaxial cervical spine slightly-lordotic (nonflexion). His motor evoked potential amplitude improved immediately during the operation, and there were improvements of myelopathy and a modest reversal of muscle wasting at 1 year postoperatively. Postoperative dynamic cervical spine MRI also demonstrated minimal cord compression and elimination of the venous plexus engorgement dorsal to the thecal sac. Although Hirayama disease is benign in nature and frequently self-limiting, multilevel instrumented ACDF could be a reasonable management option.
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Affiliation(s)
- Yi-Hsuan Kuo
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chao-Hung Kuo
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Biomedical Engineering, School of Biomedical Science and Engineering, National Yang-Ming University, Taipei, Taiwan
| | - Wen-Cheng Huang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jau-Ching Wu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Farrehi C, Pazzi C, Stillman M. A case of postprandial hypotension in an individual with cervical spinal cord injury: treatment with acarbose. Spinal Cord Ser Cases 2019; 5:75. [PMID: 31632733 PMCID: PMC6786392 DOI: 10.1038/s41394-019-0220-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/01/2019] [Accepted: 08/19/2019] [Indexed: 02/03/2023] Open
Abstract
Introduction Postprandial hypotension (PPH) is a postmeal drop in systolic blood pressure that may or may not be symptomatic. While the etiologies of PPH are incompletely understood, it is thought to occur when glucose absorption causes increased splanchnic blood flow or "pooling" in people who lack sufficient compensatory responses to support their systemic blood pressure. Postprandial hypotension is well described in individuals with neurodegenerative diseases, yet only rarely in people living with spinal cord injury (SCI). Acarbose is an alpha-glucosidase inhibitor that treats PPH by slowing gastric transit time and reducing glucose uptake in the small intestine, hence decreasing superior mesenteric artery blood flow. Case presentation A 62-year-old woman with long-standing cervical SCI presented with 5 years of worsening postprandial lightheadedness, visual "flashes", and neck pain. She had had multiple episodes of near and frank syncope and her prior medical team had initiated midodrine three times daily. We began treatment with acarbose, starting at 50 mg with each meal and rapidly titrating to 100 mg at mealtime. She noticed an immediate improvement in her symptoms and an attenuation of postmeal drops in both systolic and diastolic blood pressures. Discussion To our knowledge, this is one of the first described cases of PPH among people living with SCI. Given the autonomic dysfunction that frequently accompanies higher-level of injuries, it is possible that many more people with SCI have this condition, whether or not it is symptomatic. Acarbose is one of the several established treatments for PPH, and proved effective and tolerable for our patient.
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Affiliation(s)
| | | | - Michael Stillman
- Internal Medicine and Rehabilitation Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, 1100 Walnut Street, Suite 601, Philadelphia, PA 19107 USA
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Vora D, Schlaff CD, Rosner MK. Surgical management of a complex case of Charcot arthropathy of the spine: a case report. Spinal Cord Ser Cases 2019; 5:73. [PMID: 31632731 PMCID: PMC6786288 DOI: 10.1038/s41394-019-0217-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/01/2019] [Accepted: 08/05/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction The authors present a case of a 55-year-old male with T10 complete paraplegia diagnosed with Charcot arthropathy of the spine (CAS). Case presentation He presented to an outside institution with vomiting and productive cough with subsequent computed tomography (CT) and MRI imaging revealing L5 osteomyelitis and a paraspinal abscess. Given the patient's inability to remain in good posture in his wheelchair he underwent a multilevel vertebrectomy and thoracolumbar fusion. Due to multiple co-morbidities, surgical recovery was complex, ultimately requiring revision circumferential fixation. Discussion CAS is an uncommon, long-term complication of traumatic spinal cord injury (SCI). Surgical management is often complex and associated with significant complications. Currently, a consensus on CAS prevention, specific surgical fixation techniques and post-surgical nursing care management is lacking. In this case report we provide our experience in the management of a complex case of CAS to aid in decision making for future neurosurgeons who encounter this sequela of traumatic SCI.
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Affiliation(s)
- Darshan Vora
- Department of Neurological Surgery, The George Washington University Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, WA 20037 United States
| | - Cody D. Schlaff
- Department of Neurological Surgery, The George Washington University Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, WA 20037 United States
| | - Michael K. Rosner
- Department of Neurological Surgery, The George Washington University Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, WA 20037 United States
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Anderson KD, Bryden AM, Moynahan M. Risk-benefit value of upper extremity function by an implanted electrical stimulation device targeting chronic cervical spinal cord injury. Spinal Cord Ser Cases 2019; 5:68. [PMID: 31632726 PMCID: PMC6786403 DOI: 10.1038/s41394-019-0213-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/02/2019] [Accepted: 07/09/2019] [Indexed: 11/20/2022] Open
Abstract
Study design A cross-sectional stated-preference survey using direct-assessment questions. Objective To determine the relative value placed on different outcomes to be used in a pivotal trial for the upper extremity configuration of the Networked Neuroprosthesis (NNP) as well as the tolerance of the expected adverse event profile. Setting Academic medical center in the United States. Methods Distribution of an online survey to adults living with tetraplegia; extent of agreement with each question/statement was obtaining using a 1-7 Likert scale. Results There were 8 statements about potential benefits in arm/hand function; for all statements, more than 70% of participants rated the functions as "1-very important" to regain. There were variable degrees of concern related to risks that could occur during the 30-day post-surgical period and increasing degrees of concern related to risks that could occur in the first 5 years, potentially due to the device, based on the increasing degree of invasiveness of the intervention required to address the event. When analysing the results based on all degrees of interest, more than 64% of responders were interested in getting the NNP with a success rate threshold as low as 50% regardless of time post-injury. Chi-squared analyses revealed some associations between responses and sex, injury level, and injury duration; however, none of these were statistically significant upon post-hoc analysis. Conclusion Data here indicate that people with tetraplegia are highly interested in a range of arm/hand functions and are tolerant of expected risks that may be associated with implanted neuroprosthetics. Sponsorship The Institute for Functional Restoration funded this project through a sub-contract to K.D. Anderson from a larger Special Projects Award (grant number FP0020773) from the Craig H. Neilsen Foundation.
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Affiliation(s)
- Kim D. Anderson
- Miami Project to Cure Paralysis, Department of Neurological Surgery, University of Miami School of Medicine, Miami, FL USA
- Institute for Functional Restoration, Case Western Reserve University, Cleveland, OH USA
| | - Anne M. Bryden
- Institute for Functional Restoration, Case Western Reserve University, Cleveland, OH USA
- Department of Orthopaedics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH USA
| | - Megan Moynahan
- Institute for Functional Restoration, Case Western Reserve University, Cleveland, OH USA
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