A 72-h sedated porcine model of traumatic spinal cord injury.

Introduction: There is an increasing focus on the prevention of secondary injuries following traumatic spinal cord injury (TSCI), especially through improvement of spinal cord perfusion and immunological modulation. Such therapeutic strategies require translational and controlled animal models of disease progression of the acute phases of human TSCI. Research question: Is it possible to establish a 72-h sedated porcine model of incomplete thoracic TSCI, enabling controlled use of continuous, invasive, and non-invasive modalities during the entire sub-acute phase of TSCI? Material and methods: A sham-controlled trial was conducted to establish the model, and 10 animals were assigned to either sham or TSCI. All animals underwent a laminectomy, and animals in the TSCI group were subjected to a weight-drop injury. Animals were then kept sedated for 72 h. The amount of injury was assessed by ex-vivo measures MRI-based fiber tractography, histology and immunohistochemistry. Results: In all animals, we were successful in maintaining sedation for 72 h without comprising vital physiological parameters. The MRI-based fiber tractography showed that all TSCI animals revealed a break in the integrity of spinal neurons, whereas histology demonstrated no transversal sections of the spine with complete injury. Notably, some animals displayed signs of secondary ischemic tissue in the cranial and caudal sections. Discussion and conclusions: This study succeeded in producing a porcine model of incomplete TSCI, which was physiologically stable up to 72 h. We believe that this TSCI model will constitute a potential translational model to study the pathophysiology secondary to TSCI in humans.

Disc prosthesis versus fusion with cage in single level cervical degenerative spine disease - A retrospective case-control patient reported outcome study.

AIM: To compare the clinical outcome of single level cervical degenerative spine disease treated surgically with motion preserving anterior cervical disc arthroplasty versus anterior cervical discectomy and fusion (ACDF). METHODS: Patients treated with cervical disc arthroplasty at Aalborg University Hospital and ACDF at Aarhus University Hospital were matched 1:2. Primary outcome measures were Neck Disability Index (NDI), EQ-5D-3 L and Numeric rating scale (NRS) for arm- and neck pain. Data was collected by telephone interviews regarding present and retrospective data. RESULTS: 50 patients treated with cervical disc arthroplasty were matched to 100 ACDF patients covering November 2011 to December 2018. Mean improvements for NRS neck pain three-months postoperative, and NDI were significantly better in the cervical disc arthroplasty group, with intergroup differences of 1.56 (p = 0.02) and 5.01 (p = 0.01) respectively. A subgroup analysis of the half of the cohort with the longest follow-up (mean 7.6 years) showed, in favour of cervical disc arthroplasty, mean improvements of NDI: 8.80 (p = 0.00), EQ5D: - 0.19 (p = 0.04), NRS neck three months follow-up: 3.70 (p = 0.00) and long follow-up: 2.54 (p = 0.01) and NRS arm three months follow-up: 2.02 (p = 0.01). Radiologic examination indicated preserved mobility in 80% of the implanted protheses at 24-month post-surgical follow-up. CONCLUSION: Surgical treatment of one level degenerative cervical spine disease with cervical disc arthroplasty or anterior cervical discectomy and fusion has a similar good clinical outcome after a mean follow-up of 5.6 years. However, cervical disc arthroplasty displayed long-term superiority in the half of the cohort with the longest follow-up time averaging 7.6 years.

Incidence and risk factors for incidental durotomy in spine surgery for lumbar stenosis and herniated disc.

PURPOSE: Incidental durotomy (ID) is one of the most common complications in degenerative surgery. Due to the negative consequences of ID, knowledge about incidence and risk factors is warranted. METHODS: A total of 1,139 surgical procedures for lumbar spinal stenosis (LS) and lumbar herniated disc (LDH) were included from the spine surgery database: DaneSpine. Uni- and multivariate analyses were performed for the assessment of possible risk factors. RESULTS: ID occurred in 10.4% of the surgical procedures. A multivariate regression analysis revealed an increased relative risk of ID by 2% per year of age, 58% by revision surgery, and 55% by decompression on multiple levels. CONCLUSION: In our single-centre cohort study, one in ten patients experiences an ID. Increasing age, revision surgery and decompression of multiple levels are risk factors of ID in degenerative surgery of the lumbar spine.

Characteristics in a traumatic spinal cord injury population.

INTRODUCTION: The aim of this study was to describe core characteristics in a Danish population of rehabilitated traumatic spinal cord injury (SCI) patients. METHODS: Retrospectively, data were extracted from a database on all traumatic patients with SCI admitted to the Spinal Cord Injury Centre of Western Denmark having sustained an injury to the spinal cord between 1 January 1997 and 1 January 2017. Age is presented as medians and interquartile ranges (IQR). RESULTS: A total of 584 (women = 122; men = 462) traumatic patients with SCI with a median age of 42.9 years (26.4-58.3 years) were identified of whom 390 underwent surgery (SG) and 55 were treated conservatively forming a conservative group (CG). The acute treatment regime was unknown in 139 patients with SCI. Patients in the CG were significantly older (median 63.6 years (IQR: 39.1-71.5) than patients in the SG (median 52.8 years (IQR: 37.2-67.2), p = 0.02). The relative risk (RR) of fractures was higher in the SG (RR = 2.74 (1.91-3.95), p less than 0.0001). The initial American Spinal Injury Association Impairment Scale (AIS) grades (A, B, C and D) differed significantly (Kruskal-Wallis test, p less than 0.02) with a higher frequency of AIS Din the CG. Fewer persons with a cervical than with a non-cervical level of injury underwent spinal surgery (RR = 0.65 (0.54-0.77), p less than 0.0004). CONCLUSIONS: In a Danish population of patients with traumatic SCI, we observed a preponderance for surgical treatment among a) younger patients, b) patients with vertebral fractures, and c) more severe SCI cases. FUNDING: This study received no external funding. TRIAL REGISTRATION: The study was conducted in accordance with the Helsinki II Declaration. Data were obtained with permission from the Danish Data Protection Agency (record number 2012-41-0572).