A placebo-controlled randomized clinical trial of amantadine hydrochloride for evaluating the functional improvement of patients following severe acute traumatic brain injury.

BACKGROUND: Considering the known derangements in the dopaminergic neurotransmitter systems following traumatic brain injury (TBI), dopamine agonists are used as a pharmacologic option. In this study, we evaluate the effects of amantadine hydrochloride on the functional improvement of severe TBI patients. METHODS: Within a triple-blinded (patients, intervention administrators, and outcome assessors) placebo-controlled randomized clinical trial, we evaluated the effects of amantadine (100 mg BD (twice a day) for 14 days, then 150 mg BD for another 7 days, and 200 mg BD for another 21 days) on outcome measurements of weekly mean Glasgow Outcome Scale (GOS) and Disability Rating Scale (DRS), through six weeks of trial for 57 patients (29 amantadine, 28 placeboes) with severe TBI admitted in our hospital. RESULTS: Although both groups had improvement in their DRS, the change from baseline was significantly better in the amantadine group (10.88±5.24 for amantadine vs. 8.04±4.07 for placebo, P=0.015). No significant difference was observed between groups for GOS (1.04±0.55 for amantadine vs. 1.12±1.05 for placebo, P=0.966). CONCLUSIONS: Based on our findings, amantadine hydrochloride might improve the speed of functional ability improvement in severe TBI patients, evaluated by DRS, and is also well tolerated by patients. Although, there were some limitations in this study, including small sample size, short time interval, not providing a wash-off period and invalidity of GOS for measuring recovery rates in short-term periods.

Minimal Dose of Tranexamic Acid Is Effective in Reducing Blood Loss in Complex Spine Surgeries: A Randomized Double-Blind Placebo Controlled Study.

STUDY DESIGN: A randomized double-blind placebo controlled study. PURPOSE: In the present study, we aimed to assess the efficacy of tranexamic acid (TXA) in reducing blood loss after laminectomy and posterolateral fusion of the spine. OVERVIEW OF LITERATURE: Blood loss is the most significant complication involved with surgery, especially in spinal surgery. Multilevel laminectomy and laminectomy with instrumentation (pedicle screws and rods) are complex spine surgeries and are considered as medium-risk procedures for bleeding. Recent reports have demonstrated that the use of antifibrinolytic drugs during surgery may reduce the risk of postoperative bleeding and one of the most frequently used antifibrinolytics is TXA. METHODS: In this randomized clinical trial, 50 patients eligible for laminectomy (for ≥2 level) with postero-lateral fusion with a pedicular screw (laminectomy and posterior spinal fusion) were randomly assigned to receive preoperative single doses of intravenous TXA (15 mg/kg) or 0.9% normal saline. RESULTS: Of the 50 patients, 30 (60%) were female and 20 (40%) were male. Between-group difference with respect to the total volume of blood loss during surgery was statistically significant. CONCLUSIONS: The findings of this study suggest that TXA can reduce both intraoperative and immediate postoperative blood loss, decrease the need for packed cell transfusion, and reduce the duration of hospitalization after complex spinal surgeries. No adverse events related to the use of TXA were encountered in this study.

Ligamentum Flavum Hematoma Presented with Low Back Pain: A Case Report and Review of the Literature.

A 61-year-old woman with no past medical history presented with low back pain and radicular pain in the right lower extremity. Magnetic resonance imaging of the lumbar spine showed a heterogeneous intensity mass in the lateral recess of the spinal canal at the L4-5 disk level. Postoperatively, her radicular pain resolved within a few days with excellent low back pain relief. Ligamentum flavum hematoma is a rare differential diagnosis for cystic lesions in the lumbar spine that can be removed simply by surgery with excellent relief of symptoms and improvement in strength of the right lower extremity and increased sensitivity.

Cervical osteochondroma with neurological symptoms: literature review and a case report.

INTRODUCTION: Osteochondromas are common benign tumors of bone and spinal involvement is uncommon. Solitary spinal osteochondromas may produce a wide variety of symptoms depending on their location and relationship to adjacent neural structures. CASE PRESENTATION: Herein, we present a case of solitary osteochondroma arising from the posterior arch of C1, causing left-sided ascending numbness and paresthesia and difficulty walking. The lesion was totally resected through a posterior approach. Histopathological examination confirmed the diagnosis of benign osteochondroma. DISCUSSION: Spinal cord compression is uncommon in spinal osteochondromas because in most cases the tumor grows out of the spinal column. To prevent neurological compromise, complete surgical removal is mandatory when an intraspinal osteochondroma with cord compression is diagnosed, which also helps to prevent recurrence. Our literature review of similar cases indicates that despite the old belief that C2 is the most commonly involved vertebra for osteochondromas, C1 is actually the most commonly involved vertebra in the cervical region.