Efficacy and safety of short-term edaravone or nerve growth factor add-on therapy for alcohol-related brain damage: A multi-centre randomised control trial.

AIMS: To measure the therapeutic effect of an anti-oxidant, edaravone (EDV), or neurotrophic treatment with nerve growth factor (NGF) as an add-on treatment for alcohol-related brain damage (ARBD). DESIGN: Multi-centre, randomised, single-blinded, comparative clinical trial. SETTING AND PARTICIPANTS: One hundred and twenty-two inpatients recruited from seven hospitals in different regions of China, all diagnosed with ARBD and aged 18 to 65 years old; among them, only two were female. INTERVENTION AND COMPARATOR: Patients were randomly assigned to receive one of three treatments for 2 weeks: 40 patients, treatment as usual (TAU: a combination of intramuscular injections of thiamine, intravenous infusions of other B vitamins with vitamin C and oral medication with vitamin E per day); 40, EDV add-on treatment to TAU (intravenous infusion with 30 mg of EDV twice per day); and 42, NGF add-on treatment to TAU (intramuscular injection of 20 µg of NGF per day). The patients underwent follow-up for 24 weeks. MEASUREMENTS: The primary outcome was the composite score of executive cognitive function in the 2nd week after treatment, which was measured as the mean of the Z scores of the assessments, including the digit symbol substitute test (DSST), digit span memory test-forward (DST-F), digit span memory test-reverse (DST-R) and space span memory test (SSMT). The secondary outcomes were the composite scores at later follow-ups, the score for each component of cognitive function, global cognitive function measured by the Montreal Cognitive Assessment (MoCA), craving for alcohol and the safety of the therapies. FINDINGS: EDV add-on treatment improved the composite score of executive cognitive function better than TAU in the 2nd week (adjusted mean difference: 0.24, 95% confidence interval 0.06 to 0.41; P = 0.008), but NGF add-on treatment did not (adjusted mean difference: 0.07, 95% confidence interval -0.09 to 0.24; P = 0.502). During the follow-up to 24 weeks, EDV add-on treatment improved the composite score of executive cognitive function and DST-R score better than TAU (both P < 0.01). Craving for alcohol was relieved in all three groups. No severe adverse events were observed. CONCLUSION: The short-term addition of edaravone to supplementary therapy treatment for alcohol-related brain damage (ARBD) improved executive cognitive function in patients with ARBD.

Tuberculosis of the lower cervical spine (C5-C6) in a 24-month-old infant.

BACKGROUND: Tuberculosis (TB) of the cervical spine occurs rarely in younger children whereas the presentation and outcome are different from those of adult cervical spine. Because cervical spinal TB in younger children is rarely reported, the clinical characteristics, the treatments, and the expected outcome of treatments in younger children are still unknown. METHODS: We present a case of cervical spine TB in a 24-month-old boy that grounds severe vertebral destruction and an extradural abscess. This child presented with neurological deficit in the form of quadraparesis. We performed anterior cervical debridement for this patient; to our best knowledge, the child in this case is the youngest patient reported in the literature as having had cervical TB treated through anterior cervical surgery. RESULTS: The neurological deficits of this patient were recovered soon, and no evidence of recurrence of the tuberculous lesion or of the deformity was revealed by the 6-year follow-up magnetic resonance imaging. CONCLUSIONS: Based on our experiences in this case and a review of the literature, we propose that for patients of cervical spine TB in early childhood, anterior excision of diseased bone without grafting should be adequate as a surgical measure.

Posterior spinal fusion for scoliosis in Ehlers-Danlos syndrome, kyphoscoliosis type.

The Ehlers-Danlos syndromes comprise a clinically and genetically heterogeneous group of heritable connective tissue disorders characterized by articular hypermobility, skin extensibility, and tissue fragility. Surgical treatment of scoliosis associated with Ehlers-Danlos syndrome poses a challenge to spine surgeons because of the high risk of major complications. There is a paucity of evidence in the literature on surgical treatment for scoliosis in the Ehlers-Danlos syndrome patient.This article describes 3 adolescent patients diagnosed with Ehlers-Danlos syndrome, kyphoscoliosis type, which was treated by posterior spinal fusion only. After unsuccessful conservative treatment for at least 1 year, the patients underwent posterior spinal surgery for the correction of spinal deformity. A satisfactory correction in the spinal curve was achieved, with no obvious loss of correction during follow-up. No intra- or postoperative major complications were observed.Our experience supports that a satisfactory correction of scoliosis can be achieved by posterior spinal fusion only in patients with Ehlers-Danlos syndrome, kyphoscoliosis type.

Safe angle scope for posterior atlanto-occipital transarticular screw fixation.

OBJECTIVE: To study the technical parameters related to, and explore the clinical significance of, posterior atlanto-occipital transarticular screw fixation. METHODS: Posterior implantation of Kirschner wires via the atlanto-occipital joint was performed on 20 dry bone specimens with complete atlanto-occipital joints. The angle of the Kirschner wire was measured on a postimplantation x-ray. Three-dimensional computed tomographic reconstruction of the atlanto-occipital joint of 30 healthy adults was performed to measure the simulative safety range for screw placement in posterior atlanto-occipital transarticular screw fixation. The procedure was then conducted on 12 fresh cadaver occipitocervical specimens. X-rays and 3-dimensional computed tomographic reconstruction were performed postsurgery to verify exact screw positioning. RESULTS: The ideal angles for screw placement were cephalocaudal angle in the sagittal plane of 53.3 +/- 3.4 degrees, mediolateral angle in the coronal plane of 20.0 +/- 2.6 degrees, a maximum allowable cephalocaudal angle of 74.6 +/- 2.8 degrees (67.9-80.5 degrees), a minimum allowable cephalocaudal angle of 24.9 +/- 1.9 degrees (22.1-29.4 degrees), a maximum allowable mediolateral angle of 40.5 +/- 2.9 degrees (31.1-49.4 degrees), and a minimum allowable mediolateral angle of 0.7 +/- 1.6 degrees (-4.1-5.9 degrees). Surgery simulation in the fresh cadaver specimens indicated that this safe scope is reliable. CONCLUSION: There is a safe scope for the angle of the screw placement in posterior atlanto-occipital transarticular screw fixation. Posterior transarticular screw fixation can be safely performed for occipitocervical fusion fixation when utilizing careful screw placement.