The effect of combination therapy with erythropoietin and methylprednisolone in patients with traumatic cervical spinal cord injury: a pilot randomized controlled trial.

STUDY DESIGN: Pilot double-blinded randomized controlled trial. OBJECTIVES: To investigate the additive effect of recombinant human erythropoietin (rhEPO) on functional outcome and disability in patients with traumatic cervical spinal cord injury (TCSCI). SETTINGS: University-affiliated hospital in Mashhad, Iran. METHODS: Patients with acute TCSCI admitted within 8 h after injury were randomly assigned to receive only methylprednisolone (M group) or rhEPO 500 IU/mL plus methylprednisolone (M + E group). All the patients underwent surgery within the next several days. Neurological function was assessed on admission, and at 6th and 12th months after the injury according to the sphincter function and American spinal cord injury association (ASIA) scale. RESULTS: Overall, 54 patients (mean age: 39.7 ± 13.3 years) including 46 (85%) males were studied in two groups of 27. The likelihood of developing adverse neurological outcomes (ASIA impairment score of A compared to D or E) was not significantly different between the groups after 6 (OR = 0.39, 95% CI = 0.03-4.80, P = 0.46) and 12 months (OR = 0.83, 95% CI = 0.11-6.11, P = 0.86). The groups also showed no significant difference in 1-year mortality (OR = 0.83, 95% CI = 0.25-2.74, P = 0.76). CONCLUSIONS: It is not clear whether combination therapy with erythropoietin compared to methylprednisolone alone improves neurological functions of patients with TCSCI. Our study provides interim data to guide future larger definitive trials.

Spinopelvic Parameters among Healthy Volunteers in Iran.

BACKGROUND: Recently, in approach to spinal pathologies, the whole spine should be considered as a biomechanical unit. Studies have shown the great importance of sagittal and coronal balance and the relationship between the various parts of spine together and pelvis. Former studies have shown a close relationship between spinopelvic parameters and sagittal balance. A complete understanding of sagittal balance basics is needed to achieve the best outcome and avoiding future complications after treatment of spinal deformities. In this study, the normal range of spinopelvic parameters among healthy volunteers in Iran has been evaluated. METHODS: This cross-sectional study was conducted on healthy volunteers in 2017. The lateral whole-spine X-ray was obtained under the standard conditions. Two spine surgeons measured the parameters including pelvic incidence, pelvic tilt, sacral slope and lumbar lordosis. RESULTS: In this study 100 volunteers were studied; out of whom, 41 participants were male and the mean age was 47.5±11.7 years. The average pelvic incidence, pelvic tilt, and sacral slope were 51.5±10.9, 17.4±9.9, and 34.8±8.8 degrees, respectively. The pelvic tilt was significantly lower in women. It was found that with increasing age, the pelvic incidence and pelvic tilt increases while lumbar lordosis decreases (P<0.05). CONCLUSION: This study is the first study on the normal range of spinopelvic parameters in healthy individuals in Iran.. Our data showed that PT and PI-LL are significantly lower in women, while, PT, PI and PI-LL increase and LL decreases in older ages.

Predictive Value of Computed Tomography Scan for Posterior Ligamentous Complex Injuries in Patients with Thoracolumbar Spinal Fractures.

BACKGROUND: Thoracolumbar spinal fractures include a range of injuries of various severities from simple apophyseal fractures to neurological injury and complex fractures associated with vertebral dislocation. The treatment of thoracolumbar fractures is challenging, especially due to the difficulty of evaluating the posterior ligamentous complex (PLC). The purpose of this study was to evaluate the diagnostic value of computed tomography (CT) scan in predicting PLC injuries in the patients with thoracolumbar spinal fractures referring to the referral center of spinal trauma in the east north of Iran in 2016. METHODS: This retrospective study was conducted on patients with thoracolumbar injuries referring to Shahid Kamyab Hospital in Mashhad, east north of Iran, in 2016. The data were collected by entering the data of medical records into special forms. The classification of spinal fractures was accomplished using the AO Spine Classification System. RESULTS: According to the results, 71 (71.7%) patients were male, and the subjects had a mean age of 44.6±17.7 years. The PLC injury was observed in 28 (28.3%) patients. The PLC injury showed a significant relationship with facet joint widening, increased interspinous process distance, and spinous process avulsion fracture (P<0.05). CONCLUSION: As the findings of this study indicated, the diagnostic results of PLC injury by means of CT scan was similar to those obtained by magnetic resonance imaging in patients with thoracolumbar spinal fractures.

Malignant Cerebral Venous Infarction: Decompressive Craniectomy versus Medical Treatment.

BACKGROUND: Cerebral venous thrombosis (CVT) is a common type of stroke in young adults and associated with 8% mortality. High intracranial pressure (ICP) and brain herniation are the most common causes of death in these patients. In contrast with malignant arterial middle cerebral infarction, there are few studies reporting the efficacy of decompressive craniectomy (DC) for treatment of high ICP in patients with CVT. In this study, we assess the clinical outcome of patients with CVT with impending brain herniation treated with DC versus medical management. METHODS: In this retrospective study, medical records of all patients with CVT admitted to our hospital were reviewed. Patients with the following inclusion criteria were entered into the study: 1) CVT proven by contrast-enhanced magnetic resonance venogram and/or computed tomography venogram, 2) malignant CVT (impending brain herniation according to imaging and clinical finding), and 3) age between 16 and 80 years. Patients with deep venous system thrombosis, Glasgow Coma Scale (GCS) score of 3, and bilateral nonreactive midposition pupils or mydriasis on admission were excluded. Patients were classified into 2 groups: surgical group (DC group) including patients who received medical treatment and DC and medical group (MG) including patients who received only medical treatment. Outcomes and complications were assessed and compared between the 2 groups. RESULTS: Of 357 patients with CVT hospitalized in our center, 48 patients entered into the study. Twenty-three patients were managed medically, and 25 patients were managed surgically. There was no significant difference between the groups concerning age, sex, presenting symptoms, transient and permanent risk factors of CVT, GCS score on admission, and pupils' reactivity on admission. All patients in the MG died during hospitalization in comparison with 8 patients in the DC group (100% vs. 32%, P < 0.001). Favorable outcome (modified Rankin scale score 0-2) was achieved in 52% of the DC group and 0% of the MG group (P < 0.001). CONCLUSIONS: The results of our study confirmed that in contrast with DC, medical treatment could not prevent transtentorial herniation. DC is not only lifesaving for patients with CVT with impending brain herniation but also results in favorable outcome in most patients.

Treatment Outcomes and Prognostic Factors in Pediatric Non-brainstem Astrocytoma in North East of Iran.

BACKGROUND: Central Nervous System (CNS) tumors have accounted for approximately one fourth of all pediatric malignancies. CNS tumors have been the most common solid malignancies among the children. In this study, we have evaluated survival and prognostic factors in children with non-brain stem astrocytoma. METHODS: Children with non-brain stem astrocytoma, referring to radiation oncology centers of Ghaem and Omid hospitals of Mashhad, have included in this retrospective study, in years 2000-2010. Patients' demographic data, past medical history, clinical symptoms, extent of tumor resection and treatment modality have recorded. Disease-free survival and overall survival have measured using Kaplan-Meier method. RESULTS: We studied 87 patients with male to female ratio of 44/43 (1.02), and median age of 10 yrs (range: 2-15 yrs). Tumor grade distribution was as follows: grade I: 20 (23%) subjects; grade II: 34 (39.1%) subjects; grade III: 20 (23%) subjects; and grade IV: 13 (14.9%) subjects. The median follow-up duration was 38 months (6 to 110), and 16 months (4 to 100) for patients with low- and high-grade tumors. The 2-year survival rates in grades I-IV were 100%, 84.7%, 60% and 10.8%, respectively. Tumor resection less than gross total and non-ambulation have associated with a significantly inferior survival in both groups multivariate analysis, with high- and low-grade tumors. CONCLUSION: For all the cases of the pediatric non-brainstem astrocytoma, tumor grade had dramatic influences on their survival. Performing gross total resection was crucial for achieving favorable outcomes in both low-grade and high-grade cases. Moreover, according to the results, having major motor deficits has associated with lower survival.