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1.
Di Wu Chao Zheng Ji Wu Jing Xue Rongrong Huang Di Wu Yueming Song 《The spine journal》2017,17(11):1665-1673
Background Context
A reliable experimental rabbit model of distraction spinal cord injury (SCI) was established to successfully simulate gradable and replicable distraction SCI. However, further research is needed to elucidate the pathologic mechanisms underlying distraction SCI.Purpose
The aim of this study was to investigate the pathologic mechanisms underlying lumbar distraction SCI in rabbits.Study Design
This is an animal laboratory study.Methods
Using a self-designed spine distractor, the experimental animals were divided into a control group and 10%, 20%, and 30% distraction groups. Pathologic changes to the spinal cord microvessels in the early stage of distraction SCI were identified by perfusion of the spinal cord vasculature with ink, production of transparent specimens, observation by light microscopy, and observation of corrosion casts of the spinal cord microvascular architecture by scanning electron microscopy. Malondialdehyde (MDA) and superoxide dismutase (SOD) concentrations in the injured spinal cord tissue were measured after 8 hours.Results
With an increasing degree and duration of distraction, the spinal cord microvessels were only partially filled and had the appearance of spasm until rupture and hemorrhage were observed. The MDA concentration increased and the SOD concentration decreased in the spinal cord tissue.Conclusions
Changes to the internal and external spinal cord vessels led to spinal cord ischemia, which is a primary pathologic mechanism of distraction SCI. Lipid peroxidation mediated by free radicals took part in secondary pathologic damage of distraction SCI. 相似文献2.
Yuan Wang Qin-Jie Kong Jing-Chuan Sun Yong Yang Hai-Bo Wang Qiang Zhang Jian-Gang Shi 《The spine journal》2018,18(1):164-172
Background Context
One of the many reactive changes following a spinal cord injury (SCI) is the formation of a glial scar, a reactive cellular process whereby glial cells accumulate and surround the central nervous system injury sites to seal in the wound. Thus, the inhibition of glial scar is of great importance for SCI recovery.Purpose
This study aimed to explore the effect of lentivirus-mediated silencing of the CTGF gene on the formation of glial scar tissue in a rat model of SCI.Study Design
This is a prospective study.Study Sample
A total of 56 Wistar female rats aged 8 weeks were randomly selected for this study.Outcome Measures
The motor function of the rats was assessed using the Basso, Beattie, and Bresnahan (BBB) functional scale, footprint analysis of gait, and the Basso Mouse Scale (BMS). Quantitative real-time polymerase chain reaction, Western blotting, and immunohistochemistry were performed to detect the mRNA and protein expressions of glial fibrillary acidic protein (GFAP), vimentin, fibronectin, and laminin in the spinal cord tissues.Methods
A rat model of SCI was successfully established. Fifty-six male Wistar rats were randomly selected and assigned into four groups (14 rats in each group): the sham operation group, the SCI model group, the negative control (NC) group (SCI rats transfected with empty vector plasmids), and the siRNA-CTGF group (SCI rats transfected with lentivirus CTGF siRNA).Results
The SCI rats showed decreased activity and were dragging their bodies while moving. Compared with the sham operation group, the BBB and BMS scores in the SCI model, NC, and siRNA-CTGF groups significantly decreased. However, the BBB and BMS scores in the siRNA-CTGF group were higher than those in the SCI model and NC groups. The mRNA and protein expressions of GFAP, vimentin, fibronectin, and laminin significantly increased in the SCI model, NC, and siRNA-CTGF groups in comparison with those in the sham operation group. Furthermore, the mRNA and protein expressions of GFAP, vimentin, fibronectin, and laminin in the siRNA-CTGF group were lower than those in the SCI model and NC groups 28 days after transfection.Conclusions
These findings indicate that lentivirus-mediated silencing of the CTGF gene can suppress the formation of glial scar tissue after SCI. 相似文献3.
Bernardo De Caro Martins Bruno Benetti Junta Torres Karen Maciel de Oliveira Mario Sergio Lavor Carla Maria Osório Fabiola Bono Fukushima Isabel Rodrigues Rosado Eliane Gonçalves de Melo 《The spine journal》2018,18(3):532-539
Background Context
Damage to the spinal cord can result in irreversible impairment or complete loss of motor, sensory, and autonomic functions. Riluzole and dantrolene have been shown to provide neuroprotection by reducing neuronal apoptosis after brain and spinal cord injury (SCI) in several animal models of neurologic disorders. As these drugs protect the injured spinal cord through different mechanisms, we investigated the cumulative effects of riluzole and dantrolene.Purpose
This study aimed to investigate the neuroprotective efficacy of the combined administration of riluzole and dantrolene in experimental thoracic SCI.Study Design
Twenty-nine Wistar rats were laminectomized at T12 and divided in five groups. Rats in GI (n=6) underwent laminectomy alone and were treated with placebo. Rats in GII (n=6) underwent laminectomy followed by SCI and were treated with placebo. Rats in GIII (n=5) underwent laminectomy followed by SCI and were treated with riluzole and placebo 15 minutes and 1 hour after laminectomy, respectively. Rats in GIV (n=6) underwent laminectomy followed by SCI and were treated with placebo and dantrolene 15 minutes and 1 hour after laminectomy, respectively. Rats in GV (n=6) underwent laminectomy followed by SCI and were treated with riluzole and dantrolene 15 minutes and 1 hour after laminectomy, respectively. A compressive trauma was performed to induce SCI.Methods
Behavioral testing of hind limb function was performed using the Basso Beattie Bresnahan locomotor rating scale, which revealed significant recovery in the group treated with the association of riluzole and dantrolene compared with other groups. After euthanasia, the spinal cord was evaluated using light microscopy and immunochemistry with anti-NeuN and transferase dUTP nick-end-labeling (TUNEL) staining.Results
Animals treated with the association of riluzole and dantrolene showed a larger number of NeuN-positive neurons adjacent to the epicenter of injury (p≤.05). Furthermore, the TUNEL staining was similar between animals treated with riluzole and dantrolene and those that did not receive spinal cord trauma (p>.05).Conclusions
These results showed that riluzole and dantrolene have a synergistic effect in neuroprotection after traumatic SCI by decreasing apoptotic cell death. 相似文献4.
Rodrigo Mondragon-Lozano Camilo Ríos Ernesto Roldan-Valadez Guillermo J. Cruz Maria G. Olayo Roberto Olayo Hermelinda Salgado-Ceballos Juan Morales Marisela Mendez-Armenta Laura Alvarez-Mejia Omar Fabela Axayacatl Morales-Guadarrama Stephanie Sánchez-Torres Araceli Diaz-Ruiz 《The spine journal》2017,17(4):562-573
Background Context
Traumatic spinal cord injury (SCI) causes irreversible damage with loss of motor, sensory, and autonomic functions. Currently, there is not an effective treatment to restore the lost neurologic functions.Purpose
Injection of polypyrrole-iodine(PPy-I) particle suspension is proposed as a therapeutic strategy.Study Design
This is an in vivo animal study.Methods
This study evaluates the use of such particles in rats after SCI by examining spared nervous tissue and the Basso, Beattie, and Bresnahan (BBB) scale to evaluate the functional outcome. Diffusive magnetic resonance imaging (MRI) was employed to measure the apparent diffusion coefficient (ADC) and fractional anisotropy (FA) as non-invasive biomarkers of damage after SCI.Results
Fractional anisotropy decreased, whereas ADC increased in all groups after the lesion. There were significant differences in FA when compared with the SCI-PPy-I group versus the SCI group (p<.05). Significant positive correlations between BBB and FA (r2=0.449, p<.05) and between FA and preserved tissue (r2=0.395, p<.05) were observed, whereas significant negative associations between BBB and ADC (r2=0.367, p<.05) and between ADC and preserved tissue (r2=0.421, p<.05) were observed.Conclusions
The results suggested that PPy-I is neuroprotective as it decreased the amount of damaged tissue while improving the motor function. Non-invasive MRI proved to be useful in the characterization of SCI and recovery. 相似文献5.
Ryan D. Quarrington Claire F. Jones Petar Tcherveniakov Jillian M. Clark Simon J.I. Sandler Yu Chao Lee Shabnam Torabiardakani John J. Costi Brian J.C. Freeman 《The spine journal》2018,18(3):387-398
Background Context
Distractive flexion injuries (DFIs) of the subaxial cervical spine are major contributors to spinal cord injury (SCI). Prompt assessment and early intervention of DFIs associated with SCI are crucial to optimize patient outcome; however, neurologic examination of patients with subaxial cervical injury is often difficult, as patients commonly present with reduced levels of consciousness. Therefore, it is important to establish potential associations between injury epidemiology and radiographic features, and neurologic involvement.Purpose
The aims of this study were to describe the epidemiology and radiographic features of DFIs presenting to a major Australian tertiary hospital and to identify those factors predictive of SCI. The agreement and repeatability of radiographic measures of DFI severity were also investigated.Study Design/Setting
This is a combined retrospective case-control and reliability-agreement study.Patient Sample
Two hundred twenty-six patients (median age 40 years [interquartile range = 34]; 72.1% male) who presented with a DFI of the subaxial cervical spine between 2003 and 2013 were reviewed.Outcome Measures
The epidemiology and radiographic features of DFI, and risk factors for SCI were identified. Inter- and intraobserver agreement of radiographic measurements was evaluated.Methods
Medical records, radiographs, and computed tomography and magnetic resonance imaging scans were examined, and the presence of SCI was evaluated. Radiographic images were analyzed by two consultant spinal surgeons, and the degree of vertebral translation, facet apposition, spinal canal occlusion, and spinal cord compression were documented. Multivariable logistic regression models identified epidemiology and radiographic features predictive of SCI. Intraclass correlation coefficients (ICCs) examined inter- and intraobserver agreement of radiographic measurements.Results
The majority of patients (56.2%) sustained a unilateral (51.2%) or a bilateral facet (48.8%) dislocation. The C6–C7 vertebral level was most commonly involved (38.5%). Younger adults were over-represented among motor-vehicle accidents, whereas falls contributed to a majority of DFIs sustained by older adults. Greater vertebral translation, together with lower facet apposition, distinguished facet dislocation from subluxation. Dislocation, bilateral facet injury, reduced Glasgow Coma Scale, spinal canal occlusion, and spinal cord compression were predictive of neurologic deficit. Radiographic measurements demonstrated at least a “moderate” agreement (ICC>0.4), with most demonstrating an “almost perfect” reproducibility.Conclusions
This large-scale cohort investigation of DFIs in the cervical spine describes radiographic features that distinguish facet dislocation from subluxation, and associates highly reproducible anatomical and clinical indices to the occurrence of concomitant SCI. 相似文献6.
Michael K. Urban Kara Fields Sean W. Donegan Jonathan C. Beathe David W. Pinter Oheneba Boachie-Adjei Ronald G. Emerson 《The spine journal》2017,17(12):1889-1896
Background Context
Lidocaine has emerged as a useful adjuvant anesthetic agent for cases requiring intraoperative monitoring of motor-evoked potentials (MEPs) and somatosensory-evoked potentials (SSEPs). A previous retrospective study suggested that lidocaine could be used as a component of propofol-based intravenous anesthesia without adversely affecting MEP or SSEP monitoring, but did not address the effect of the addition of lidocaine on the MEP and SSEP signals of individual patients.Purpose
The purpose of this study was to examine the intrapatient effects of the addition of lidocaine to balanced anesthesia on MEPs and SSEPs during multilevel posterior spinal fusion.Study Design
This is a prospective, two-treatment, two-period crossover randomized controlled trial with a blinded primary outcome assessment.Patient Sample
Forty patients undergoing multilevel posterior spinal fusion were studied.Outcome Measures
The primary outcome measures were MEP voltage thresholds and SSEP amplitudes. Secondary outcome measures included isoflurane concentrations and hemodynamic parameters.Methods
Each participant received two anesthetic treatments (propofol 50?mcg/kg/h and propofol 25?mcg/kg/h+lidocaine 1?mg/kg/h) along with isoflurane, ketamine, and diazepam. In this manner, each patient served as his or her own control. The order of administration of the two treatments was determined randomly.Results
There were no significant within-patient differences between MEP threshold voltages or SSEP amplitudes during the two anesthetic treatments.Conclusions
Lidocaine may be used as a component of balanced anesthesia during multilevel spinal fusions without adversely affecting the monitoring of SSEPs or MEPs in individual patients. 相似文献7.
Tiina Ihalainen Irina Rinta-Kiikka Teemu M. Luoto Tuomo Thesleff Mika Helminen Anna-Maija Korpijaakko-Huuhka Antti Ronkainen 《The spine journal》2018,18(1):81-87
Background Context
Laryngeal penetration-aspiration, the entry of material into the airways, is considered the most severe subtype of dysphagia and is common among patients with acute cervical spinal cord injury (SCI).Purpose
The aim of this study was to investigate risk factors for penetration-aspiration in patients with acute traumatic cervical spinal cord injury (TCSCI).Study Design
This is a prospective cohort study.Patient Sample
Thirty-seven patients with TCSCI were included in the study.Outcome Measures
The highest Rosenbek penetration-aspiration scale (PAS; range 1–8) score of each patient was the primary outcome measure. The risk factors consisted of patient characteristics, demographics, and clinical signs observed during a clinical swallowing trial.Materials and Methods
A clinical swallowing trial and videofluoroscopic swallowing study (VFSS) was performed on all patients within 28 days post injury. For group comparisons, the patients were divided into two groups: (1) penetrator-aspirators (PAS score ≥3) and (2) non-penetrator-aspirators (PAS score ≤2).Results
Of the 37 patients, 83.8% were male. The mean age at the time of the injury was 61.2 years. Most patients had an incomplete TCSCI (78.4%) caused by a fall (75.7%). In the VFSS, 51.4% of the patients were penetrator-aspirators, and 71.4% had silent aspiration. The risk factors for predicting penetration-aspiration were (1) necessity of bronchoscopies, (2) lower level of anterior cervical operation, (3) coughing, throat clearing, choking related to swallowing, and (4) changes in voice quality related to swallowing. Binary logistic regression identified coughing, throat clearing, choking, and changes in voice quality related to swallowing as independent risk factors for penetration-aspiration.Conclusions
The necessity of bronchoscopies, postinjury lower cervical spine anterior surgery, coughing, throat clearing, choking, and changes in voice quality related to swallowing was a markedrisk factor for aspiration and penetration following a cervical SCI. These factors and signs should be used to suspect injury-related pharyngeal dysfunction and to initiate preventive measures to avoid complications. The clinical swallowing evaluation is a relevant adjunct in the management of these patients and can improve the detection of penetration and aspiration. 相似文献8.
Björn Knutsson Sebastian Mukka Jens Wahlström Bengt Järvholm Arkan S. Sayed-Noor 《The spine journal》2018,18(8):1313-1317
Background Context
Tobacco smoking is an injurious habit associated with a number of chronic disorders. Its influence on disc metabolism and degeneration including lumbar spinal stenosis (LSS) has been investigated in the literature.Purpose
We aimed to investigate whether tobacco smoking is an independent risk factor for undergoing surgical intervention for LSS.Study Design/Setting
This is a prospective cohort study.Patient Sample
The patient sample of 331,941 workers was derived from a Swedish nationwide occupational surveillance program for construction workers.Outcome Measure
The outcome measure included the incidence of undergoing surgical intervention for LSS in tobacco smokers versus no smokers.Materials and Methods
At inclusion, age, sex, body mass index (BMI), workers' job title, and self-reported smoking habits were registered. The workers were divided into four categories: never smoked, former smoker, moderate current (1–14 cigarettes/day), and heavy current (≥15 cigarettes/day). Patients who underwent a surgically treated LSS were defined using the relevant International Classification of Diseases (ICD) disease code derived from the Swedish National Patient Register.Results
A total of 331,941 participants were included in the analysis. Forty-four percent of the participants were non-smokers, 16% were former smokers, 26% were moderate smokers, and 14% were heavy smokers. The vast majority of construction workers were males (95%). During the average follow-up of 30.7 years, 1,623 participants were surgically treated for LSS. The incidence rate ratio (IRRs) of LSS varied across smoking categories, with the highest values found in heavy smokers. Compared with non-smokers, all smoking categories show an increased incidence of surgically treated LSS. The findings were consistent even when the comparison was performed for participants with BMIs between 18.5 and 25 and for participants aged between 40 and 74 years.Conclusions
Tobacco smoking is associated with an increased incidence of surgically treated LSS. The effect seems to be dose related, whereby heavy smokers have a higher risk than moderate or former smokers. 相似文献9.
Narihito Nagoshi Lindsay Tetreault Hiroaki Nakashima Aria Nouri Michael G. Fehlings 《The spine journal》2017,17(2):291-302
Study Design
This is a systematic review.Purpose
The study aimed to evaluate whether spinal cord concussion (SCC) patients can safely return to play sports and if there are factors that can predict SCC recurrence or the development of a spinal cord injury (SCI).Background Context
Although SCC is a reversible neurologic disturbance of spinal cord function, its management and the implications for return to play are controversial.Methods
We conducted a systematic search of the literature using the keywords Cervical Spine AND Sports AND Injuries in six databases. We examined return to play in patients (1) without stenosis, (2) with stenosis, and (3) who underwent single-level anterior cervical discectomy and fusion (ACDF). We also investigated predictors for the risk of SCC recurrence or SCI.Results
We identified 3,655 unique citations, 16 of which met our inclusion criteria. The included studies were case-control studies or case series and reports. Two studies reported on patients without stenosis: pediatric cases returned without recurrence, whereas an adult case experienced recurrent SCC after returning to play. Seven studies described patients with stenosis. These studies included cases with and without recurrence after return to play, as well as patients who suffered SCI with permanent neurologic deficits. Three studies reported on patients who underwent an ACDF. Although some patients played after surgery without problems, several patients experienced recurrent SCC due to herniation at levels adjacent to the surgical sites. With respect to important predictors, a greater frequency of patients who experienced recurrence of symptoms or SCI following return to play had a “long” duration of symptoms (>24 hours; 36.36%) compared with those who were problem-free (11.11%; p=.0311).Conclusions
There is limited evidence on current practice standards for return to play following SCC and important risk factors for SCC recurrence or SCI. Because of small sample sizes, future prospective multicenter studies are needed to determine important predictive factors of poor outcomes following return to play after SCC. 相似文献10.
Background Context
Recurrence of spinal epidural abscess (SEA) after treatment is an important cause of continued morbidity for patients.Purpose
The purpose of this study was to identify independent predictors of recurrence of SEA.Study Design/Setting
This was a retrospective, case-control study.Patient Sample
Patients 18 years or older with a diagnosis of SEA admitted to our hospital system during the study period were included in the study sample.Outcome Measures
The outcome measure was recurrence of SEA, defined as a reaccumulation of pus or infected granulation tissue in the epidural space after initial treatment.Methods
All patients older than 18 years admitted to our hospital system with a diagnosis of SEA from 1993 to 2016 were identified, and explanatory variables and outcomes were collected retrospectively. Patients 18 years or older diagnosed with SEA were included. We excluded patients whose treatment was initiated at an outside institution. Bivariate and multivariate analyses were performed to identify independent predictors of recurrence.Results
We identified 1,053 patients with SEA. We only considered patients to be recurrence-free if they had no documented recurrence with greater than 20 weeks of follow-up. Five hundred thirty-four patients were recurrence-free and 38 had documented recurrence, yielding 572 patients who were included in this analysis. Bivariate and multivariate analyses identified three independent predictors of recurrence: history of intravenous drug use, fecal incontinence or retention, and local spinal wound infection.Conclusions
Patients with SEA who have a history of intravenous drug use, bowel dysfunction at presentation, or concurrent local spinal wound infection are at increased risk of disease recurrence. These patients ought to be closely followed up after discharge, with frequent serial imaging and aggressive antibiotic treatment. 相似文献11.
Malte Ohlmeier Eduardo M. Suero Mirko Aach Renate Meindl Thomas A. Schildhauer Mustafa Citak 《The spine journal》2017,17(10):1519-1522
Background Context
Heterotopic ossification (HO) is a known complication especially in people with traumatic spinal cord injury (SCI). Although some risk factors have already been described, the pathophysiology of HO is still unknown. The pelvis is the most common region for HO occurrence. However, the prevalence of HO by muscle groups about the hip is not well described.Purpose
To analyze the prevalence of early HO in muscle groups about the hip in 267 patients with SCI.Patient Sample
267 patients with traumatic SCI and pelvic HO.Methods
Between January 2001 and December 2014, 267 patients with SCI were treated in our university hospital and were included in the study. Patients were routinely screened for HO using ultrasound. The diagnosis of HO was validated using magnetic resonance imaging (MRI) or computed tomography (CT). The primary outcome measure was the prevalence of HO by muscle groups around the hip. The following muscle groups around the hip were defined: (1) gluteal group, (2) adductor group, (3) iliopsoas group, and (4) deep muscle group. Additionally, the prevalence of concomitant trochanteric bursitis was recorded in all cases.Results
The gluteal group showed the highest HO prevalence with 55.8%, followed by the deep muscle group with 31.1%. Concomitant trochanteric bursitis was found in 62 patients (23.2%). No association between pelvic trauma and HO development was observed (n=16, 11%).Conclusions
The most common muscular location for the occurrence of HO about the hip was the gluteal muscle group. Considering that no laboratory parameters are currently available for screening for HO, highly sensitive ultrasound screening examinations should be routinely performed, with particular attention paid to the gluteal muscles. Additionally, routine range of motion examination for extension and external rotation of the hip joint is warranted. 相似文献12.
Jérôme Paquet Carly S. Rivers Dilnur Kurban Joel Finkelstein Jin W. Tee Vanessa K. Noonan Brian K. Kwon R. John Hurlbert Sean Christie Eve C. Tsai Henry Ahn Brian Drew Christopher S. Bailey Daryl R. Fourney Najmedden Attabib Michael G. Johnson Michael G. Fehlings Stefan Parent Marcel F. Dvorak 《The spine journal》2018,18(1):88-98
Background Context
Emergent surgery for patients with a traumatic spinal cord injury (SCI) is seen as the gold standard in acute management. However, optimal treatment for those with the clinical diagnosis of central cord syndrome (CCS) is less clear, and classic definitions of CCS do not identify a unique population of patients.Purpose
The study aimed to test the authors' hypothesis that spine stability can identify a unique group of patients with regard to demographics, management, and outcomes, which classic CCS definitions do not.Study Design/Setting
This is a prospective observational study.Patient Sample
The sample included participants with cervical SCI included in a prospective Canadian registry.Outcome Measures
The outcome measures were initial hospitalization length of stay, change in total motor score from admission to discharge, and in-hospital mortality.Methods
Patients with cervical SCI from a prospective Canadian SCI registry were grouped into stable and unstable spine cohorts. Bivariate analyses were used to identify differences in demographic, injury, management, and outcomes. Multivariate analysis was used to better understand the impact of spine stability on motor score improvement. No conflicts of interest were identified.Results
Compared with those with an unstable spine, patients with cervical SCI and a stable spine were older (58.8 vs. 44.1 years, p<.0001), more likely male (86.4% vs. 76.1%, p=.0059), and have more medical comorbidities. Patients with stable spine cervical SCI were more likely to have sustained their injury by a fall (67.4% vs. 34.9%, p<.0001), and have high cervical (C1–C4; 58.5% vs. 43.3%, p=.0009) and less severe neurologic injuries (ASIA Impairment Scale C or D; 81.3% vs. 47.5%, p<.0001). Those with stable spine injuries were less likely to have surgery (67.6% vs. 92.6%, p<.0001), had shorter in-hospital lengths of stay (median 84.0 vs. 100.5 days, p=.0062), and higher total motor score change (20.7 vs. 19.4 points, p=.0014). Multivariate modeling revealed that neurologic severity of injury and spine stability were significantly related to motor score improvement; patients with stable spine injuries had more motor score improvement.Conclusions
We propose that classification of stable cervical SCI is more clinically relevant than classic CCS classification as this group was found to be unique with regard to demographics, neurologic injury, management, and outcome, whereas classic CCS classifications do not . This classification can be used to assess optimal management in patients where it is less clear if and when surgery should be performed. 相似文献13.
Kazuki Kusuyama Toshiya Tachibana Hiroki Yamanaka Masamichi Okubo Shinichi Yoshiya Koichi Noguchi 《The spine journal》2018,18(6):1062-1069
Background Context
Spinal cord injury (SCI) commonly results not only in motor paralysis but also in the emergence of neuropathic pain (NeuP), both of which can impair the quality of life for patients with SCI. In the clinical field, it is well known that pregabalin, which binds to the voltage-gated calcium channel alpha-2-delta-1 (α2δ-1) subunit has therapeutic effects on NeuP after SCI. A previous study has demonstrated that SCI increased α2δ-1 in the L4–L6 dorsal spinal cord of SCI rats by Western blot analysis and that the increase of α2δ-1 was correlated with tactile allodynia of the hind paw. However, the detailed feature of an increase in α2δ-1 protein in the spinal dorsal horn and the mechanism of pregabalin effect on SCI-induced NeuP have not been fully examined.Purpose
This study aimed to examine the detailed distribution of α2δ-1 expression in the lumbar spinal cord after thoracic SCI in rats and the correlation of the therapeutic effect of pregabalin in SCI rats.Study Design
Male Sprague-Dawley rats underwent thoracic (T10) spinal cord contusion injury using the IH impactor device. Spinal cord injury rats received pregabalin (30?mg/kg) once a day for 2 weeks over a 4-week period after SCI.Methods
The mechanical threshold in the rat hind paw was measured over 4 weeks. Alpha-2-delta-1 expression in the lumbar spinal cord and in the dorsal root ganglion (DRG) was analyzed using immunohistochemistry and in situ hybridization histochemistry.Results
A significant reduction of the withdrawal threshold of mechanical stimuli to the hind paw was observed for 2 weeks and continued at least 4 weeks after SCI. In the control rats, expression of α2δ-1 immunoreactivity was detected mainly in laminae I and II in the lumbar dorsal horn. Thoracic SCI significantly increased α2δ-1 immunoreactivity in laminae I and II in the lumbar dorsal horn 4 weeks after SCI; however, thoracic SCI did not affect the expression of α2δ-1 mRNA in the L4 and L5 DRGs. Meanwhile, the signal intensity of α2δ-1 mRNAs in the lumbar spinal cord increased from Day 7 and continued for at least 28 days after SCI. Cellular analysis showed that SCI increased the number of α2δ-1-expressing cells in laminae I and II. The tactile allodynia of the hind paw in the SCI rats was reversed after pregabalin treatment and was maintained for 21 days. This administration of pregabalin decreased the α2δ-1 immunoreactivity significantly in the lumbar dorsal horn of thoracic SCI rats at 28 days after SCI.Conclusions
The present study results suggest that an increase of α2δ-1 in the L4 and L5 dorsal horns after thoracic SCI is derived from the increase in the expression in lumbar spinal neurons. This increase may be involved in the development of NeuP in the hind paws and the therapeutic effect of pregabalin on central NeuP after SCI. 相似文献14.
Ariel Christian Jullien-Petrelli J.L. García-Sabrido M.I. Orue-Echebarria P. Lozano A. Álvarez J. Serrano F.M. Calvo J.A. Calvo-Haro J.M. Lasso J.M. Asencio 《The spine journal》2018,18(4):632-638
Background Context
Sacral chordoma is a rare entity with high local recurrence rates when complete resection is not achieved. To date, there are no series available in literature combining surgery and intraoperative radiotherapy (IORT).Purpose
The objective of this study was to report the experience of our center in the management of sacral chordoma combining radical resection with both external radiotherapy and IORT.Study Design
This is a retrospective case series.Patient Sample
The patient sample included 15 patients with sacral chordoma resected in our center from 1998 to 2015.Outcome Measures
The outcome measures were overall survival (OS), disease-free survival (DFS), and rates of local and distant recurrences.Methods
We retrospectively reviewed the records of all the patients with sacral chordoma resected in our center from 1998 to December 2015. Overall survival, DFS, and rates of local and distant recurrences were calculated. Results between patients treated with or without IORT were compared.Results
A total of 15 patients were identified: 8 men and 7 women. The median age was 59 years (range 28–77). Intraoperative radiotherapy was applied in nine patients and six were treated with surgical resection without IORT. In 13 patients, we performed the treatment of the primary tumor, and in two patients, we performed the treatment of recurrence disease. A posterior approach was used in four patients. Wide surgical margins (zero residue) were achieved in six patients, marginal margins (microscopic residue) were achieved in seven patients, and there were no patients with intralesional (R2) margins. At a median follow-up of 38 months (range 11–209 months), the 5-year OS in the IORT group was 100% versus 53% in the group of non-IORT (p=.05). The median DFS in the IORT group was 85 months, and that in the non-IORT group was 41 months. In the group without IORT, two patients died and nobody died during the follow-up in the group treated with IORT. High–sacrectomy treated patients had a median survival of 41 months, and low–sacrectomy treated patients had a median survival of 90 months. Disease-free survival in patients without gluteal involvement was 100% at 5 years, and that in patients with gluteal involvement was 40%. All patients with a recurrence in our study had gluteal involvement.Conclusions
Multidisciplinary management of sacral chordoma seems to improve local control. The use of IORT, in our experience, is associated with an increase in OS and DFS. The level of resection and gluteal involvement seems to affect survival. The posterior approach is useful in selected cases. Multicenter studies should be performed to confirm the utility of IORT. 相似文献15.
Background Context
A conventional weight drop spinal cord (SC) impact system for large animals is composed of a high-speed video camera, a vision system, and other things. However, a camera with high speed at over 5,000 frames per second (FPS) is very expensive. In addition, the use of the vision system involves complex pattern recognition algorithms and accurate arrangement of the camera and the target.Purpose
The purpose of this study was to develop a large animal spinal cord injury (SCI) modeling system using a multimodal sensor instead of a high-speed video camera and vision system. Another objective of this study was to demonstrate the possibility of the developed system to measure the impact parameters in the experiments using different stiffness materials and an in vivo porcine SC.Study Design
A multimodal sensor-based SCI impact system was developed for large animals. The experiments to measure SC impact parameters were then performed using three different stiffness materials and a Yucatan miniature pig to verify the performance of system developed.Methods
A comparative experiment was performed using three different stiffness materials such as high-density (HD) sponge, rubber, and clay to demonstrate the system and perform measurement for impact parameters such as impact velocity, impulsive force, and maximally compressed displacement reflecting physical properties of materials. In the animal experiment, a female Yucatan miniature pig of 60-kg weight was used. Impact conditions for all experiments were fixed at freefalling object mass of 50?g and height of 20?cm.Results
In the impact test, measured impact velocities were almost the same for the three different stiffness materials at 1.84±0.0153?m/s. Impulsive forces for the three materials of rubber, HD sponge, and clay were 50.88 N, 32.35 N, and 6.68 N, respectively. Maximally compressed displacements for rubber, HD sponge, and clay were 1.93?mm, 3.35?mm, and 15.01?mm, respectively. In the pig experiment, impact velocity, impulsive force, and maximally compressed dural displacement were measured at 1.84?m/s, 13.35 N, and 3.04?mm, respectively. After 3 days from the experiment, paralysis was confirmed for the lower half body of the experimental pig.Conclusions
Through experiments, it was verified that our proposed system could be used to measure the SC impact parameters and induce SCI for large animals. 相似文献16.
Douglas S. Weinberg Brian Z. Hedges Jonathan E. Belding Timothy A. Moore Heather A. Vallier 《The spine journal》2017,17(10):1449-1456
Background Context
Previous studies have suggested pulmonary complications are common among patients undergoing fixation for traumatic spine fractures. This leads to prolonged hospital stay, worse functional outcomes, and increased economic burden. However, only limited prognostic information exists regarding which patients are at greatest risk for pulmonary complications.Purpose
This study aimed to identify factors predictive of perioperative pulmonary complications in patients undergoing fixation of spine fractures.Study Design/Setting
A retrospective review in a level 1 trauma center was carried out.Patient Sample
The patient sample comprised 302 patients with spinal fractures who underwent operative fixation.Outcome Measures
The outcome measures were postoperative pulmonary complications (physiological and functional measures).Materials and Methods
Demographic and injury features were recorded, including age, gender, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, mechanism of injury, injury characteristics, and neurologic status. Treatment details, including surgery length, timing, and approach were reviewed. Postoperative pulmonary complications were recorded after a minimum of 6 months' follow-up.Results
Forty-seven pulmonary complications occurred in 42 patients (14%), including pneumonia (35), adult respiratory distress syndrome (ARDS) (10), and pulmonary embolism (2). Logistic regression found spinal cord injury (SCI) to be most predictive of pulmonary complications (odds ratio [OR]=4.4, 95% confidence interval [CI] 1.9–10.1), followed by severe chest injury (OR 2.7, 95% CI 1.1–6.9), male gender (OR 2.7, 95% CI 1.1–6.8), and ASA classification (OR 2.3, 95% CI 1.4–4.0). Pulmonary complications were associated with significantly longer hospital stays (23.9 vs. 7.7 days, p<.01), stays in the intensive care unit (ICU) (19.9 vs. 3.4 days, p<.01), and increased ventilator times (13.8 days vs. 1.9 days, p<.01).Conclusions
Several factors predicted development of pulmonary complications after operative spinal fracture, including SCI, severe chest injury, male gender, and higher ASA classification. Practitioners should be especially vigilant for of postoperative complications and associated injuries following upper-thoracic spine fractures. Future study must focus on appropriate interventions necessary for reducing complications in these high-risk patients. 相似文献17.
Xavier Bonfill David Rigau Manuel Esteban-Fuertes Juana M. Barrera-Chacón María L. Jáuregui-Abrisqueta Sebastian Salvador Carolina M. Alemán-Sánchez Albert Borau Manuel Bea-Muñoz Begoña Hidalgo Maria J. Andrade Juan R. Espinosa María José Martínez-Zapata 《The spine journal》2017,17(11):1650-1657
Background
Patients with spinal cord injury (SCI) who carry indwelling urinary catheters have an increased risk of urinary tract infection (UTI). Antiseptic silver alloy-coated (SAC) silicone urinary catheters prove to be a promising intervention to reduce UTIs; however, current evidence cannot be extrapolated to patients with SCI.Purpose
This study aimed to assess the efficacy of SAC urinary catheters for preventing catheter-associated urinary tract infections.Design/Setting
This is an open-label, multicenter (developed in Spain, Portugal, Chile, Turkey, and Italy), randomized clinical trial conducted in 14 hospitals from November 2012 to December 2015.Patient Sample
Eligible patients were men or women with traumatic or medical SCI, aged ≥18 years, requiring an indwelling urinary catheter for at least 7 days.Outcome Measures
The primary outcome was the incidence of symptomatic UTIs. The secondary outcome included bacteremia in the urinary tract and adverse events.Materials and Methods
Patients were randomized to receive a SAC urinary catheter (experimental group) or a standard catheter (control group) for at least 7 days. Data were compared using chi-squared test and also calculating the absolute risk difference with a 95% confidence interval. An adjusted analysis including different risk factors of UTI was performed. This study was mainly funded by La Marató de TV3 Foundation (grant number # 112210) and the European Clinical Research Infrastructures Network organization. The funders had no role in the interpretation or reporting of results.Results
A total of 489 patients were included in the study, aged 55 years in the experimental group and aged 57 in the control group (p=.870); 72% were men; 43% were hospitalized patients, and 57% were outpatients (p=1.0). The most frequent cause of SCI was traumatic (73.75%), and the localization was mainly the cervical spine (42.74%). Most of the patients had an A score (complete spinal injury and no motor and sensory is preserved) on the ASIA scale (62.37%). The median time of urethral catheterization was 27 days in the experimental group and 28 days in the control group (p=.202). Eighteen patients (7.41%) in the experimental group and 19 in the control (7.72%) group had a symptomatic UTI (odds ratio [OR] 0.96 [0.49–1.87]). The adjusted analysis revealed no change in the results. Only three patients in the experimental group had bacteremia within the urinary tract. The experimental group presented more adverse events related to the use of a catheter than the control group (OR 0.03 [0.00–0.06]).Conclusions
The results of this study do not support the routine use of indwelling antiseptic SAC silicone urinary catheters in patients with SCI. However, UTIs associated to long-term urinary catheter use remain a challenge and further investigations are still needed. 相似文献18.
19.
Michael G. Fehlings So Kato Lawrence G. Lenke Hiroaki Nakashima Narihito Nagoshi Christopher I. Shaffrey Kenneth M.C. Cheung Leah Carreon Mark B. Dekutoski Frank J. Schwab Oheneba Boachie-Adjei Khaled M. Kebaish Christopher P. Ames Yong Qiu Yukihiro Matsuyama Benny T. Dahl Hossein Mehdian Ferran Pellisé-Urquiza Sigurd H. Berven 《The spine journal》2018,18(10):1733-1740
Background Context
Significant variability in neurologic outcomes after surgical correction for adult spinal deformity (ASD) has been reported. Risk factors for decline in neurologic motor outcomes are poorly understood.Purpose
The objective of the present investigation was to identify the risk factors for postoperative neurologic motor decline in patients undergoing complex ASD surgery.Study Design/Setting
This is a prospective international multicenter cohort study.Patient Sample
From September 2011 to October 2012, 272 patients undergoing complex ASD surgery were prospectively enrolled in a multicenter, international cohort study in 15 sites.Outcome Measures
Neurologic decline was defined as any postoperative deterioration in American Spinal Injury Association lower extremity motor score (LEMS) compared with preoperative status.Methods
To identify risk factors, 10 candidate variables were selected for univariable analysis from the dataset based on clinical relevance, and a multivariable logistic regression analysis was used with backward stepwise selection.Results
Complete datasets on 265 patients were available for analysis and 61 (23%) patients showed a decline in LEMS at discharge. Univariable analysis showed that the key factors associated with postoperative neurologic deterioration included older age, lumbar-level osteotomy, three-column osteotomy, and larger blood loss. Multivariable analysis revealed that older age (odds ratio [OR]=1.5 per 10 years, 95% confidence interval [CI] 1.1–2.1, p=.005), larger coronal deformity angular ratio [DAR] (OR=1.1 per 1 unit, 95% CI 1.0–1.2, p=.037), and lumbar osteotomy (OR=3.3, 95% CI 1.2–9.2, p=.022) were the three major predictors of neurologic decline.Conclusions
Twenty-three percent of patients undergoing complex ASD surgery experienced a postoperative neurologic decline. Age, coronal DAR, and lumbar osteotomy were identified as the key contributing factors. 相似文献20.
Ibrahim Hussain Ori Barzilai Anne S. Reiner Natalie DiStefano Lily McLaughlin Shahiba Ogilvie Mark Bilsky Ilya Laufer 《The spine journal》2018,18(2):261-267