Can magnetic resonance imaging findings effectively diagnose the instability observed on radiographs in patients with degenerative lumbar spinal stenosis?

BACKGROUND: Degenerative lumbar spinal stenosis (LSS) is a common condition that involves the narrowing of the spinal canal. Diagnosing instability traditionally requires standing lateral radiographs to detect dynamic translation, but there is debate about relying solely on radiographs due to challenges like patient discomfort and radiation exposure. This study aimed to evaluate if Magnetic Resonance Imaging (MRI) findings could effectively diagnose instability observed on radiographs. METHODS: We reviewed 478 consecutive patients with degenerative LSS who had surgery at our institution. Instability was defined as a sagittal translation exceeding 3 mm on standing lateral radiographs in both extension and flexion. Patients were divided into stable (those with < 3 mm translation) and unstable groups (those with > 3 mm translation). The study assessed potential variables for instability, including MRI findings like facet joint effusion, facet joint angle, disk height index, intradiscal vacuum presence, endplate sclerosis, ligamentum flavum hypertrophy, and multifidus muscle fatty degeneration, comparing these factors between the two groups. RESULTS: A total of 478 consecutive patients diagnosed with degenerative Lumbar Spinal Stenosis (LSS) were included. The average age of the patients was 66.32 years, with 43.3% being male. Approximately 27.6% of the cases exhibited signs of instability on the standing lateral radiograph during extension and flexion. The multivariate analysis using binary logistic regression revealed that facet joint effusion (odds ratio [OR] 2.73; 95% confidence interval [CI] 1.27-3.94; P = 0.002), disk height index (OR 2.22; 95% CI 1.68-3.35; P = 0.009), and the presence of the Vacuum sign (OR 1.77; 95% CI 1.32-2.84; P = 0.021) were identified as factors associated with instability. CONCLUSIONS: Our findings showed thata higher facet joint effusion, the presence of Vacuum sign, and a greater Disk Height Index were associated with the presence of instability on the standing lateral radiograph in extension and flexion in patients with degenerative LSS.

Evaluation of clinical outcomes, complication rate, feasibility, and applicability of transfacet pedicle-sparing approach in thoracic disc herniation: a systematic review and meta-analysis.

OBJECTIVE: This study aimed to evaluate the clinical outcomes, complication rate, feasibility, and applicability of transfacet pedicle-sparing approach for treating thoracic disc herniation. METHODS: We searched three databases including the Cochrane Library, PubMed, and Embase for eligible studies until Dec 2022. The quality of studies and their risk of bias were assessed using the methodological index for non-randomized studies. We evaluated the heterogeneity between studies using the I2 statistic and the P-value for the heterogeneity. RESULTS: A total of 328 patients described in 11 included articles were published from 2009 to 2022. Pain outcomes using the visual analog scale (VAS score) were reported in four studies. The standardized mean difference was reported as 0.749 (CI 95% 0.555-0.943). The obtained result showed the positive effect of the procedure and the improvement of patients' pain after the surgery. Myelopathy outcomes using the Nurick score were reported in five studies. The standardized mean difference was reported as 0.775 (CI 95% 0.479-1.071). The result showed the positive effect of the procedure. Eight studies assessed postoperative complications and neurological deterioration. The pooled overall complication was 12.4% (32/258) and 3.5% (9/258) neurological worsening. CONCLUSION: The results of this study demonstrated a positive effect of the transfacet pedicle-sparing approach on the clinical outcomes of patients with thoracic disc herniation surgery. The technique has been shown to be safe and effective for the right patient. The technique is associated with lower rates of complications and a shorter hospital stay compared to other surgical approaches. This information can assist clinicians in making informed decisions when selecting the most appropriate surgical technique for their patients with thoracic disc herniation.

Is periodontitis associated with the risk of immune-mediated systemic conditions?

AIM: This study evaluates the long-term risk of immune-mediated systemic conditions in individuals with periodontitis compared to those without. DATA SOURCES: A structured online search was conducted in Medline, Cochrane library, and EMBASE using MeSH terms. All the databases were explored from initiation to June 2022. Reference lists of the eligible studies were hand searched as well. STUDY SELECTION: Peer-reviewed longitudinal retrospective/prospective cohorts and randomized controlled trials comparing incident metabolic/autoimmune/inflammatory diseases in periodontitis to healthy individuals were deemed eligible. Only studies with a minimum follow-up of one year were included. DATA EXTRACTION AND SYNTHESIS: The authors checked demographics, data source, exclusion/inclusion criteria, total follow-up duration, disease outcome, and limitations to determine the eligible studies. After assessing the risk of bias for the included studies using the Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tool, the authors used the following measures to quantify the disease outcome: relative risk (RR), odds ratio (OR), and hazard ratio (HR). Systemic conditions were categorized as immune-mediated via disrupted metabolic networks (diabetes, kidney disease, liver disease, metabolic syndrome) or chronic inflammation (inflammatory bowel disease, osteoporosis, RA, psoriasis, Sjogren's syndrome), hence recognized as metabolic or autoimmune/inflammatory diseases, respectively. A random effect meta-analysis was used to synthesize the risk of developing each disease. The authors performed subgroup analysis for periodontitis diagnosis type (self-report/clinically diagnosed) and severity. They also conducted a sensitivity analysis to assess the effect of removing studies that did not adjust for smoking status. RESULTS: From 3354 studies, 166 full texts were screened. Finally, 30 studies were deemed eligible for the systematic review, of which 27 made it to the meta-analysis. The risks of diabetes, rheumatoid arthritis (RA) and osteoporosis were increased in individuals with periodontitis compared to those without periodontitis (diabetes-relative risk [RR]: 1.22, 95% CI: 1.13-1.33; RA-RR: 1.27, 95% CI: 1.07-1.52; osteoporosis-RR: 1.40, 95% CI: 1.12-1.75). The risk of diabetes showed a gradient increase by periodontitis severity (moderate-RR = 1.20, 95% CI = 1.11-1.31; severe-RR = 1.34, 95% CI = 1.10-1.63). CONCLUSIONS: People with moderate-to-severe periodontitis have the highest risk of developing diabetes. In contrast, the effect of periodontal severity on the risk of other immune-mediated systemic conditions requires further investigation. More homologous evidence is needed to assess the periodontitis-multimorbidity association further.

Predictors of poor clinical outcome in patients with cervical spondylotic myelopathy undergoing cervical laminectomy and fusion.

BACKGROUND: Cervical spondylotic myelopathy (CSM) is a common degenerative disease that arises from spinal cord compression and injury. Laminectomy with posterior spinal fusion (LPSF) is one of the most common approaches used to treat patients with CSM. The present study aimed to evaluate predictors of poor clinical outcome in patients with CSM undergoing LPSF. METHODS: We retrospectively evaluated 157 patients with CSM who underwent LPSF at our center between April 2014 and June 2019. The neurological outcome was assessed using the modified Japanese Orthopaedic Association (mJOA) scale before the surgery and at the last follow-up visit. Based on the clinical outcomes, all patients were divided into two groups [the good group (recovery rates ≥ 75%) and the poor group (recovery rates < 75%)]. The following suggested variables as potential predictors for the poor clinical outcome were compared between the two groups:age, gender, body mass index (BMI), smoking, diabetes, number of laminectomy levels, presence of signal changes in Magnetic Resonance Imaging (MRI), duration of symptoms, preoperative JOA scale, preoperative Pavlov ratio, preoperative cervical curvature, and preoperative cervical range of motion (ROM). RESULTS: There were 86 males (54.8%) and 71 females (45.2%) with the mean follow-up time of 24.96 ± 1.67 months. Overall, 114 patients (72.6%) had a good clinical outcome. However, 43 subjects (27.4%) failed to achieve a good outcome. According to the binary logistic regression analysis, age (odds ratio [OR], 2.14; 95% confidence interval [95% CI], 1.87-2.63; P = 0.014) and preoperative JOA scale (OR, 3.73; 95% CI 2.96-4.87; p < 0.001) were independent predictors of poor clinical outcome. CONCLUSIONS: The results of the present study showed that age and preoperative JOA scale were predictors of poor clinical outcome in patients with CSM undergoing LPSF. These findings will be of great value in preoperative counseling and management of postoperative expectations.

Baseline neutrophil-lymphocyte ratio can be associated with hematoma expansion in patients with intracerebral hemorrhage: a retrospective observational study.

BACKGROUND: Hematoma expansion can be related to increased mortality and poor clinical outcomes in patients with intracerebral hemorrhage (ICH). So, early identification and prevention of hematoma expansion can be considered as an important therapeutic aim. This study aimed to evaluate the hypothesis that the neutrophil to lymphocyte ratio (NLR) is associated with hematoma expansion in ICH patients. METHODS: We retrospectively evaluated the clinical data of a total of 221 patients with ICH who were treated in our department between April 2018 and April 2021. The demographic, clinical, radiological, and laboratory test data including the NLR upon admission were investigated. A binary logistic regression analysis was used to assess the independent associations between different variables and hematoma expansion. RESULTS: A total of 221 patients with ICH were included. There were 122 (55.2%) males and 99 (44.8%) females. The mean age (years) at admission was 66.43 ± 8.28. The hematoma expansion occurred in 57 (25.8%) cases. The results of the multivariate analysis showed that hematoma volume at baseline (OR, 3.12; 95% CI 1.78-5.02; P < 0.001), admission systolic blood pressure (OR, 2.87; 95% CI 1.79-4.34; P = 0.013), Glasgow Coma Scale (GCS) (OR, 1.94; 95% CI 1.45-2.93; P = 0.020), and NLR (OR, 1.74; 95% CI 1.16-2.60; P = 0.032) were correlated with hematoma expansion in these patients. CONCLUSIONS: Our findings suggest that NLR can be a predictor of hematoma expansion in patients with ICH. This cost-effective and easily available biomarker could be used to early prediction of hematoma expansion in these patients.

Modafinil exerts anticonvulsive effects against lithium-pilocarpine-induced status epilepticus in rats: A role for tumor necrosis factor-α and nitric oxide signaling.

BACKGROUND: Status epilepticus (SE) is a continuous episode of seizures which leads to hippocampal neurodegeneration, severe systemic inflammation, and extreme damage to the brain. Modafinil, a psychostimulant and wake-promoting agent, has exerted neuroprotective and anti-inflammatory effects in previous preclinical studies. The aim of this study was to assess effects of modafinil on the lithium-pilocarpine-induced SE rat model and to explore possible involvement of tumor necrosis factor-α (TNF-α) and nitric oxide (NO) pathways in this regard. METHODS: Status epilepticus was provoked by injection of lithium chloride (127 mg/kg, intraperitoneally [i.p]) and pilocarpine (60 mg/kg, i.p.) in rats. Animals received different modafinil doses (50, 75, 100, and 150 mg/kg, i.p.) and SE scores were documented over 3 hours of duration. Moreover, the role of the nitrergic pathway in the effects of modafinil was evaluated by injection of the non-selective NO synthase (NOS) inhibitor L-NG-Nitro arginine methyl ester (L-NAME, 10 mg/kg, i.p.), the selective neuronal NOS inhibitor 7-nitroindazole (30 mg/kg, i.p.), and the selective inducible NOS inhibitor aminoguanidine (100 mg/kg, i.p.) 15 min before saline/vehicle or modafinil. The ELISA method was used to quantify TNF-α and NO metabolite levels in the isolated hippocampus. RESULTS: Modafinil at 100 mg/kg significantly decreased SE scores (P < 0.01). Pre-treatment with L-NAME, 7-nitroindazole, and aminoguanidine significantly reversed the anticonvulsive effects of modafinil. Status epilepticus-induced animals showed significantly higher NO metabolite and TNF-α levels in their hippocampal tissues, an effect that was reversed by modafinil (100 mg/kg, i.p.) treatment. Administration of NOS inhibitors resulted in excessive NO level reduction but an escalation of TNF-α level in modafinil-treated SE-animals. CONCLUSION: Our study revealed anticonvulsive effects of modafinil in the lithium-pilocarpine-induced SE rat model via possible involvement of TNF-α and nitrergic pathways.

Dynamics of neutrophil-to-lymphocyte ratio can be associated with clinical outcomes of children with moderate to severe traumatic brain injury: A retrospective observational study.

BACKGROUND: The neutrophil to lymphocyte ratio (NLR) has been reported to be associated with clinical outcomes of patients with severe traumatic brain injury (TBI). This study aimed to evaluate the correlation between the dynamics of NLR and clinical outcomes of pediatric patients with moderate to severe TBI. METHODS: We retrospectively evaluated the clinical data of a total of 374 pediatric patients with moder-ate to severe TBI who were treated in our department between May 2016 and May 2020. Clinical and laboratory data including the NLR upon admission and the NLR on hospital day four were collected. Poor clinical outcome was defined as Glasgow Outcome Scale (GOS) of 1-3. Multivariable logistic regression analyses were performed to investigate the correlation between the dynamics of NLR and clinical outcome. RESULTS: Three hundred seventy-four pediatric patients (mean age 7.37 ± 3.11, 52.7% male) were evaluated. Based on the ROC curves, a value of 5 was determined as the NLR cut-off value. The corresponding cutoff value for delta NLR was 1. The Glasgow Coma Scale (GCS) (OR, 3.42; 95% CI: 1.88-5.28; P <0.001), the light reflex (OR, 1.79; 95% CI: 1.34- 2.84; P = 0.027), the Rotterdam CT score (OR, 2.71; 95% CI: 1.72-4.13; P = 0.021), and delta NLR (OR, 1.71; 95% CI: 1.13- 2.52; P = 0.034) were identified as independent predictors for unfavorable outcomes in multivariable logistic regression analysis. CONCLUSIONS: The result of the present study suggest that delta NLR could be a predictor of poor clinical outcome of pediatrics with moderate to severe TBI. This cost-effective and easily available biomarker could be used to predict clinical outcomes in these patients.

Dapsone Protects Against Lithium-Pilocarpine-Induced Status Epilepticus in Rats through Targeting Tumor Necrosis Factor-α and Nitrergic Pathway.

Background and Purpose: Status epilepticus (SE) results in permanent neuronal brain damage in the central nervous system. One of the complex etiologies underlying SE pathogenesis is neuroinflammation. Dapsone has been recently considered as a potential neuroprotective agent in neuroinflammatory conditions. Therefore, the present study aims to investigate effects of dapsone on lithium-pilocarpine-induced SE in rats and assess whether tumor necrosis factor-alpha (TNF-α) and nitric oxide (NO) pathway participate in this effect. Methods: SE was established by injecting lithium chloride (127 mg/kg, intraperitoneally [i.p.]) and pilocarpine (60 mg/kg, i.p.). The animals received pre-treatment dapsone (2, 5, 10, and 20 mg/kg, oral gavage) and post-treatment dapsone (10 mg/kg). Subsequently, seizure score and mortality rate were documented. To assess the underlying signaling pathway, L-Nω-Nitro-L-arginine methyl ester hydrochloride (a non-specific NO synthase [NOS] inhibitor), 7-nitroindazole (a specific neuronal NOS inhibitor), and aminoguanidine (a specific inducible NOS inhibitor) were administered 15 minutes before dapsone (10 mg/kg) pre- or post-treatment. Hippocampal tissue TNF-α and NO concentrations were quantified using the enzyme-linked immunosorbent assay method. Results: Dapsone (10 mg/kg) pre-and post-treatment significantly attenuated the increased seizure score and mortality rate due to lithium-pilocarpine-induced SE. The development of SE in animals was associated with higher TNF-α and NO metabolites levels, which notably decreased in the dapsone-treated rats. Moreover, co-administration of NOS inhibitors with dapsone markedly reversed the anti-epileptic effects of dapsone and caused an escalation in TNF-α level but a significant reduction in NO concentration level. Conclusions: It seems that dapsone may exert an anti-epileptic effect on lithium-pilocarpine-induced SE through TNF-α inhibition and modulation of the nitrergic pathway.