The Importance of Spinopelvic Parameters in Recurrent Lumbar Disk Herniation.

STUDY DESIGN: Retrospective clinical study. OBJECTIVES: We aimed to investigate preoperative spinopelvic mismatch as a risk factor for recurrent lumbar disk herniation (RLDH) in patients undergoing lumbar disk herniation (LDH) surgery. SUMMARY OF BACKGROUND DATA: Spinopelvic parameters have been associated with lumbar degenerative diseases, particularly LDH. However, the relationship between these parameters and RLDH has yet to be studied. MATERIALS AND METHODS: Data of 1453 patients aged ≥18 who underwent single-level, unilateral fenestration microdiscectomy for the first time in our hospital between 2013 and 2019 were reviewed. The study group comprised 88 patients who underwent surgery for RLDH. The control group comprised 101 randomly selected patients who underwent surgery for LDH but not RLDH. Age, sex, body mass index, occupational activity level, operative level, Roussouly classification type, and time to recurrence were recorded. Moreover, pelvic incidence, lumbar lordosis (LL), interverteberal disk height (IDH), segmental lordosis, sacral slope (SS), pelvic tilt (PT), and sacral table angle (ST) were measured for each patient. Pelvic mismatch was calculated. RESULTS: Mean age was 46.5±11.4 y (range, 20-70). Both groups were similar concerning age, sex, body mass index, occupational activity level, and level of surgery. The mean time to recurrence was 167.3±36.6 d (range, 62-363). Measurements in the RLDH group were as follows: IDH=7.6±1.5 mm, pelvic incidence =54.4°±10.1°, LL=47.3°±13°, segmental lordosis =9.3°±5°, SS=35.1°±9.9°, and PT=19.3°±7.3°. Mean IDH was significantly lower in the RLDH group ( P =0.02). Less LL and lower PT at L3-4 level and increased SS at L5-S1 level were considered risk factors for RLDH. CONCLUSION: This study showed that preoperative low IDH is at higher risk for RLDH in patients undergoing LDH surgery. LL, PT, and SS may be risk factors for specific levels.

A new posterior stabilization technique in pediatric subaxial cervical vertebrae: Stabilization of spinous processes with the microplate/screw system: A radiological anatomy study.

BACKGROUND: There are limited options for posterior stabilization techniques in cases of cervical subaxial instability in children. We designed this study to investigate whether the spinous process (SP) stabilization, which was previously used in adults, can also be used in children. METHODS: Children aged 4-12 years who were admitted to our hospital between 2012 and 2020 and underwent 3D cervical computed tomography (CT) were retrospectively screened. Children without cervical spine fractures, tumors, deformities, or any ab-normalities and motion artifacts on CT were included in the study. Eight hundred seventy children were identified. Then, 360 children randomly selected from the patient pool were divided into nine different age groups or 3 different age groups (4-6 years, 7-9 years, and 10-12 years). The length, height, thickness, and anomalies of subaxial SPs were studied on CT images of children. The suitability of the SPs for the microplate/screw stabilization system was investigated. RESULTS: The suitability rate for screw insertion was 57.6% and the suitability rate for the stabilization in at least one segmental unit was 74.7%. The eligibility rate for stabilization involving C3, 4, 5, 6, and 7 vertebrae was 16.1%. There were nine different stabilization combinations and C6-7 segmental unit (71.9%) were the most common in those combinations. Bifidity prevented screw insertion in 21% of children. We found that the screw acceptance rate of SP started to increase statistically around 8 years of age and the number of segmental units that could be stabilized was at the age of 10-12 at most. CONCLUSION: According to the results of this study, we believe that the SP stabilization method recommended for children can be used as a salvage method, to support anterior stabilization or alone in a small number of selected cases.

Comparison of the effect of bipolar coagulation and fibrillar structured oxidized cellulose on formation epidural fibrosis in rats

Background/aim: Epidural fibrosis (EF) is a common cause of failed back surgery syndrome seen after spinal surgeries. The most frequent reason for the formation of EF is accumulated blood and its products in the operation zone. On the development of EF, the effect of bipolar coagulation and fibrillar oxidized cellulose, which are used frequently to control bleeding, was investigated. Materials and methods: In the study, 45 male Sprague Dawley rats were divided into three groups (control, fibrillar, and bipolar). Lumbar laminectomy was applied to all rats under sterile conditions. In the control group, the epidural area was washed with saline solution. Bleeding was controlled with fibrillar oxidized cellulose in the fibrillar group, with bipolar coagulation in the bipolar group. The area to which laminectomy had been applied was removed as a block 6 weeks later and evaluated histopathologically and genetically in terms of EF development. Fibrosis degree was determined histopathologically by counting fibroblasts using the modified Lubina and EF He grading systems. Interleukin-6 (IL-6), transforming growth factor beta-1 (TGFß-1), and mRNA levels were measured by the droplet digital polymerase chain reaction method. Results: The number of epidural fibroblasts, percentage of modified Lubina, amount of IL-6, and He grading rates were significantly lower in the fibrillar group than in the bipolar and control groups (p ˂ 0.05). On the other hand, there was no significant difference among the control, fibrillar, and bipolar groups in terms of TGFß-1 values (p= 0.525). Conclusion: The use of fibrillar oxidized cellulose was more effective for hemostasis than bipolar coagulation in reducing the development of EF.

The calcimimetic R-568 attenuates subarachnoid hemorrhage-induced vasospasm through PI3K/Akt/eNOS signaling pathway in the rat model.

Cerebral vasospasm (CVS) causes mortality and morbidity in patients after subarachnoid hemorrhage (SAH). The mechanism and adequate treatment of CVS are still elusive. R-568 is a calcimimetic agent known to exert a vasodilating effect. However, there is no report on its vasodilator effect against SAH-induced vasospasm. In the present study, we investigated the therapeutic effect of R-568 on the SAH-induced CVS model in rats. Seventy-two adult male Sprague-Dawley rats were divided into 8 groups: sham surgery; SAH only; SAH + Vehicle, SAH + R-568; SAH + R-568 + Wortmannin (the PI3K inhibitor); SAH + Wortmannin; SAH + R-568 + Calhex-231 (a calcilytic agent); SAH + Calhex-231. SAH was induced by blood (0.3 mL) given by intracisternal injection. R-568 (20 µM) was administered intracisternal immediately prior to experimental SAH. Basilar arteries (BAs) were obtained to evaluate PI3K/Akt/eNOS pathway (immunoblotting) and morphological changes 48 h after SAH. Perimeters of BAs were decreased by 24.1% in the SAH group compared to the control group and the wall thickness was increased by 75.3%. With R-568 treatment, those percentages were 9.6% and 29.6%, respectively, indicating that vasospasm was considerably improved when compared with the SAH group (P < 0.001 in both). While p-PI3K/PI3K and p-Akt/Akt ratio and eNOS protein expression were markedly decreased in the SAH rats, treatment with R-568 resulted in a significant increase in these levels. The beneficial effects of R-568 were partially blocked in the presence of Calhex-231 and completely blocked in the presence of Wortmannin. Herein, we found that treatment with R-568 would attenuate SAH-induced CVS through the PI3K/Akt/eNOS pathway and demonstrate therapeutic promise in CVS treatment following SAH.

Suitability of the Subaxial Cervical Laminae for Laminar Screws in the Pediatric Population: A Radiologic Anatomical Study.

INTRODUCTION: The laminar screw method was popularized during recent years. Since no data exist in the literature on its suitability for subaxial levels in the pediatric population, a radiologic anatomical study was planned to evaluate the suitability of the laminae for laminar screws in children. METHODS: The laminar thicknesses from C3 to C7 were measured in axial sections in 120 pediatric patients using computed tomography. The patients were divided into 3 age-groups: ages 4-6, 7-9, and 10-12. Each age-group consisted of 20 boys and 20 girls. The suitability of the laminae was evaluated for 3.5-mm-thick commercially available screws and also for the 3-mm screws that could be produced in the future. If the height of the base of the spinous process is ≥ 9 mm, the segment was accepted as suitable for the bilateral screw, and ≥5 mm is for the unilateral screw. Additionally, laminar thickness and length were measured for possible short screws longer than 15 mm in the laminae that were distally thin but proximally thick. RESULTS: The C4 and C5 levels had the thinnest (2.77 ± 0.6 mm and 2.81 ± 0.6 mm, respectively) and C7 had the thickest laminae (4.66 ± 0.6 mm) in all age-groups. No significant differences were found between boys and girls and right and left laminae. According to the age-groups, an increase in laminar thickness was possible by growing, but only C7 laminae thickness was statistically different between 10-12 and 4-6 age-groups (p < 0.001). The last rate of the suitability was 9.1% for the 3.5-mm-thick screws and 13.75% for the 3-mm-thick screws after deletion of the bilateral insertion due to the short base of the spinous process and adding the possible short screws in the distally thin but proximally thick laminae. The rates increased with age, but the only statistically significant difference was found between 4-6- and 10-12-year-old age-groups (p < 0.001). CONCLUSIONS: Laminar screws may be suitable for some levels of C7, C6, and C3 even in the young pediatric population. The use of thinner screws (3 mm) may increase the suitability rate. Therefore, laminar screw choice may be considered as a salvage method in pediatric patients, and all laminae may be evaluated individually for suitability. This study did not evaluate the safety and efficacy of the method in children, and these issues must be studied further.

Perceived Risk of Fish Consumption in a Low Fish Consumption Country.

Among the numerous health benefits of fish consumption, perhaps the most recognized is the role of omega-3 fatty acids in the prevention of cardiovascular disease. Cardiovascular disease is prevalent in Hungary, which has the lowest fish consumption in Europe. Increasing fish consumption is the aim of most European countries and given the high incidence of cardiovascular disease in Hungary, it is of particular importance. A significant reduction of the VAT for fish in 1 January 2018 aimed to increase fish consumption in Hungary. However, despite reduced VAT, the price of fish in Hungary rose from 2017 to 2018. The aim of our research is to explore perceived risks that serve to exacerbate Hungarian consumers' low fish consumption, and to measure their effects to identify potential strategies to most effectively increase fish consumption. We applied partial least squares structural equation modeling (PLS-SEM) to analyze responses provided by 1042 survey participants (collected with face-to-face interviews, using quota sampling in 2014) to explore variables of fish consumption associated with perceived risk including psychological, physical, social, and functional risks. Our model is the first one that applies detailed perceived risk categories to measure those effects on low fish consumption. The results indicate that psychological risk associated with negative past experiences have both a direct, and through functional risk, an indirect significant negative effect on fish consumption. Conversely, neither social nor physical risk impede Hungarian fish consumption. We conclude that the seafood industry could benefit from targeted interventions that seek to reduce functional risk-perception of the person responsible for preparing fish in the household.

Immediate versus delayed primary repair of the sciatic nerve in a nerve transaction model in rats.

BACKGROUND: The debate continues concerning surgical timing in a peripheral nerve injury. This study aims to evaluate the result of immediate versus delayed primary (after seven days) repair of peripheral nerve injury. METHODS: In this study, Wistar rats were divided into four groups as follows: The nerve was sharply transected in Group 1, 2 and 4. It was immediately sutured in Group 1 and sutured seven days later in Group 2, and it was not sutured in Group 4. In Group 3, the left sciatic nerve was only explored. Eight weeks later, tissue samples were extracted from the injured nerve area. Both gastrocnemius muscles were weighed. The nerve samples were examined for axon degeneration. Myelin vacuolization, axon irregularity, and edema/inflammation parameters were evaluated. RESULTS: There were not any significant differences in the score of axon degeneration and the weight of the gastrocnemius muscle between the immediate and delayed primary repair groups. However, these parameters were significantly better in both repair groups than to be in the control group and significantly worse than to be in the sham-operated group. CONCLUSION: To delay the repair about one week did not affect the histological results and weight of the muscle that was innervated by the sectioned nerve comparing to be in the immediate repair in a sciatic nerve transaction model in rats.

Is spinal computed tomography necessary in pediatric trauma patients?

BACKGROUND: To investigate the prevalence of findings of spinal injury on computed tomography (CT) images of pediatric trauma patients and to define indicators for the possible presence of spinal injuries. METHODS: Spinal CT for pediatric trauma patients (age ≤ 12 years) over a 2-year period was retrospectively evaluated for the presence of findings suggestive of spinal injury. RESULTS: Of the 773 patients reviewed, 19 (2.4%) showed traumatic spinal lesions on their spinal CT images. These patients were significantly older than those without spinal lesions (mean age 7.9 ± 3.3 years vs 6.1 ± 3.3 years; P = 0.02). The prevalence of spinal trauma was significantly lower in patients aged 0-8 years than in those aged 9-12 years (P = 0.025). Spinal injury was significantly higher in female patients (P = 0.014). Most of the spinal injuries were located at the lumbar and sacral vertebral levels, and most did not cause neurological complications or require surgical treatment. Important indicators of the possible presence of spinal injuries were pain, tenderness, or ecchymosis over the spine, a low Glasgow Coma Scale score (≤12), head injury (for cervical injuries), or intrathoracic injuries and pelvic fractures (for lumbar and sacral injuries). CONCLUSIONS: Most spinal CT examinations for the diagnosis of spinal injuries in children did not show positive findings. Thus, many children were exposed to an unnecessary high dose of radiation. New clinical evaluation criteria and indicators should be defined to diagnose spinal injuries and avoid unnecessary radiological examinations.

Television Tip-Over Related Head Injuries: A Particular Type of Child Neglect.

AIM: To identify, report, and raise awareness of the risk factors for television (TV) tip-over. MATERIAL AND METHODS: In total, 86 children who were brought to the emergency service and hospitalized at the neurosurgery clinic because of TV tip-over-related head trauma between August 2011 and August 2016 were included in the study. RESULTS: The 86 patients consisted of 47 males and 39 females. The mean age was 38.8 ± 19.5 (9â€"102) months. Low education level of the mother was a risk factor for this type of accident (p=0.009). In all the patients, injuries were caused by the tip-over of a cathode ray tube (CRT) TV. In 66 patients (77%), only the TV tipped over onto the child, whereas in 20 cases (23%), the TV tipped over with the TV stand. The TVs were not fixed to the stand or the wall in any of the homes. According to computerized tomography findings, 12 patients (13.9%) had intracranial hemorrhage and 19 patients (22%) had skull fractures. Five patients underwent neurosurgical intervention. Eighty-four patients (97.6%) were discharged with a GCS level of 15. One patient was discharged with a GCS level of 9/15 with a tracheostomy and nasogastric tube. One patient died. CONCLUSION: TV tip-over causes physical injury that may result in serious neurological damage and even death. It is becoming more common and may be prevented by taking simple precautions.

Metastatic Gallbladder Carcinoma in Meningioma: A Case Report.

Metastases from tumors to systemic cancers are rare. The most common intracranial recipient tumor is meningioma. Metastasis from gallbladder cancer has been previously reported from only one patient during autopsy. We present a case of a 72-year-old woman who underwent surgery for right frontal skull base meningioma. The tumor was completely removed. Histological specimens showed gallbladder carcinomatous metastasis with diffuse neuroendocrine differentiation in meningothelial meningioma. The Ki-67 proliferation index of the meningioma was 3%. Further, 60% positive immunoreactivity with the progesterone receptor was observed in meningioma cells. In carcinoma cells, diffuse positive immunoreactivity with chromogranin, CDX2, CEA, panCK, cytokeratin 7, and synaptophysin was observed. A combination of molecular, metabolic, immunological, and/or hormonal factors may contribute to the pathogenesis of this lesion. It cannot be ruled out that it is more common than expected.

The effectiveness of pedicle screw immersion in vancomycin and ceftriaxone solution for the prevention of postoperative spinal infection: A prospective comparative study.

OBJECTIVE: The aim of this study was to evaluate the efficacy of the local application of vancomycin hydrochloride (HCl)-ceftriaxone disodium hemiheptahydrate onto implants before using them to prevent postoperative infection. METHODS: The study included 239 patients (153 women and 86 men; mean age: 48.23 ± 16.77 years) who had thoracolumbar stabilization with transpedicular screws. All surgeries were performed by the same surgeon. Patients were divided into two groups. In the group 1 (n = 104), implants were bathed in a solution of local prophylactic antibiotics for 5 seconds just before implantation. In the group 2 (n = 135), implants were not bathed before implantation. Local antibiotics used in the study was effective against gram positive bacteria (including methicillin resistant Staphylococcus aureus) and gram negative bacteria. The rate of surgical site infection and wound healing time were compared between the groups. RESULTS: A total of 10 patients (4.1%) had deep wound infection and 20 (8.4%) had superficial infection. The most common bacteria was Staphylococcus aureus. One patient died 21 days after the surgery because of sepsis. The wound healed in a mean of 9.66 ± 2.04 days in patients who had no infection and in 32.33 ± 19.64 days in patients with infection (p < 0.001). The patients in group 1 had significantly less deep infection than the patients in group 2 (p < 0.05). However, there was no statistically significant difference between the groups for superficial infection. Patients with vertebral fracture had significantly lower deep infection rate in group 1. The deep infection rate of group 1 patients with diabetes, with bleeding of more than 2000 mL, transfused with blood transfusions above 3 units and with dural injury was significantly lower than those in the group 2. None of the patients had allergic reactions to the drugs used for local prophylaxis. CONCLUSIONS: This study shown that bathing implants in antibiotics solution was an effective local prophylactic method to prevent deep infections in spinal surgeries with instrumentation. LEVEL OF EVIDENCE: Level III, Therapeutic study.

Risk Factors and Compression and Kyphosis Rates after 1 Year in Patients with AO type A Thoracic, Thoracolumbar, and Lumbar Fractures Treated Conservatively.

AIM: Conservative treatment is a frequently used treatment modality for traumatic thoracolumbar fractures. However, not many studies evaluating radiological and clinical results of conservative treatment are found. The aim of this study was to determine the risk factors, and compression and kyphosis rates after 1 year in patients with AO type A thoracic, thoracolumbar, and lumbar fractures treated conservatively. MATERIAL AND METHODS: Radiological and clinical results of 79 thoracolumbar fractures in 57 patients, who were treated conservatively, were evaluated one year after trauma. Fractures were classified according to thoracolumbar injury classification and severity (TLICS) score and AO spinal trauma classification system. Compression rate, wedge and kyphosis angles, and sagittal index were calculated in early and late periods after trauma. RESULTS: Female/male ratio was 25/32, and mean age was 41.7±16.7 years. They were followed for 15.2±4.9 months. Mean compression rates were 19.6% and 25.2%; wedge angles were 10.1 and 12.7 degrees; kyphosis angles were 5.82 and 8.9 degrees; and sagittal indexes were 8.01 and 10.13 in all patients just after trauma and after one year, respectively. Fractures in older patients ( > 60 years of age) and in patients with osteopenia or osteoporosis, located in the thoracolumbar junction, AO type A2 and A3 fractures, and solitary fractures had higher compression and kyphosis rates at last follow-up. CONCLUSION: Early mobilization without bed rest for stable thoracolumbar fractures according to the TLICS system is a good treatment option, and radiological and clinical results are usually acceptable. However, fractures in patients older than 60 years, those with osteoporosis or osteopenia, fractures located in the thoracolumbar junction, solitary fractures, and fractures in AO type A2 or A3, are more inclined to increase in compression and kyphosis and may require a closer follow-up.

Use and modifications of cervical and upper thoracic laminar screws in posterior stabilization.

AIM: Laminar screw technique is used to stabilize C2 and other levels when other techniques cannot be performed. MATERIAL AND METHODS: The patients underwent laminar screws at cervical and upper thoracic levels in our clinic during 5 yearswere evaluated retrospectively. RESULTS: In 25 patients, 6 to 82 years old,total 54 laminar screws were used. Most frequent diagnoses were cervical spinal stenosis and craniovertebraljunction anomalies.There were handicaps to perform other type of screwsin 19 out of 25 screws during first 4 years, and 9 out of 29 in the last year (p=0.0009).Two modifications were performed in some cases. In 4 segments with thin lamina, a shorter screw was performed to leave clear the thinnest part, and in 3 C2 levels with almost full length bifid spinous process,shorter screws were inserted from medial sides of the bifid processes with a more vertical orientation. There was ventral cortex penetration in 11 screws without new neurological deficits. One of them was removed because of its full thickness insertion into the spinal canal.Fusion rate was 75% in 16 patients followed radiologically longer than 6 months.In one patient out of 4 without fusion, unilateral screw was loosened, and in others laminar screws were not loosened. CONCLUSION: Laminar screw technique is easy, safe and effective at C2, C7 and upper thoracic levels. Some modifications may be required due to the anatomical variations.It can be used at other subaxial levels also in theselected cases that other techniques could not be performed.

Neurotoxic effects of levobupivacaine and fentanyl on rat spinal cord / Efeitos neurotóxicos de levobupivacaína e fentanil sobre a medula espinhal de ratos / Efectos neurotóxicos de la levobupivacaína y el fentanilo sobre la médula espinal de ratones

BACKGROUND: The purpose of the study was to compare the neurotoxic effects of intrathecally administered levobupivacaine, fentanyl and their mixture on rat spinal cord. METHODS: In experiment, there were four groups with medication and a control group. Rats were injected 15 µL saline or fentanyl 0.0005 µg/15 µL, levobupivacaine 0.25%/15 µL and fentanyl 0.0005 µg + levobupivacaine 0.25%/15 µL intrathecally for four days. Hot plate test was performed to assess neurologic function after each injection at 5th, 30th and 60th min. Five days after last lumbal injection, spinal cord sections between the T5 and T6 vertebral levels were obtained for histologic analysis. A score based on subjective assessment of number of eosinophilic neurons - Red neuron - which means irreversible neuronal degeneration. They reflect the approximate number of degenerating neurons present in the affected neuroanatomic areas as follows: 1, none; 2, 1-20%; 3, 21-40%; 4, 41-60%; and 5, 61-100% dead neurons. An overall neuropathologic score was calculated for each rat by summating the pathologic scores for all spinal cord areas examined. RESULTS: In the results of HPT, comparing the control group, analgesic latency statistically prolonged for all four groups.In neuropathologic investment, the fentanyl and fentanyl + levobupivacaine groups have statistically significant high degenerative neuron counts than control and saline groups. CONCLUSIONS: These results suggest that, when administered intrathecally in rats, fentanyl and levobupivacaine behave similar for analgesic action, but fentanyl may be neurotoxic for spinal cord. There was no significant degeneration with levobupivacaine, but fentanyl group has had significant degeneration. .

JUSTIFICATIVA: O objetivo deste estudo foi comparar os efeitos neurotóxicos da administração por via intratecal de levobupivacaína e fentanil e suas misturas sobre a medula espinhal de ratos. MÉTODOS: O experimento compreendeu quatro grupos que receberam medicamento e um grupo controle. Os ratos foram submetidos a injeção de salina (15 µL) ou fentanil (0,0005 µg/15 mL), levobupivacaína a 0,25% (15 µL) e fentanil (0,0005 µg + levobupivacaína a 0,25%/15 µL) por via intratecal durante quatro dias. O teste de placa quente foi usado para avaliar a função neurológica após cada injeção nos minutos cinco, 30 e 60. Cinco dias após a última injeção lombar, secções da medula espinhal entre os níveis vertebrais T5 e T6 foram obtidas para análise histológica. Usamos um escore com base na avaliação subjetiva do número de neurônios eosinofílicos (neurônios vermelhos), o que significa degeneração neuronal irreversível. Esses neurônios refletem o número aproximado de neurônios em degeneração presentes nas áreas neuroanatômicas afetadas da seguinte forma: 1 = nenhum; 2 = 1-20%; 3 = 21-40%; 4 = 41-60% e 5 = 61-100% neurônios mortos. Um escore neuropatológico global foi calculado para cada rato pela soma dos escores patológicos para todas as áreas examinadas da medula espinhal. RESULTADOS: Nos resultados do TPQ, comparando o grupo controle, a latência analgésica foi estatisticamente prolongada para todos os quatro grupos.Em investimento neuropatológico, os grupos fentanil e fentanil + levobupivacaína apresentaram degeneração neuronal em contagens significativamente mais altas di que os grupos controle e salina. CONCLUSÕES: Esses resultados sugerem que fentanil e levobupivacaína, quando administrados por via intratecal em ratos, se comportam de forma semelhante à ação analgésica, mas fentanil pode ser neurotóxico para a medula espinhal. Não houve degeneração significativa com levobupivacaína, mas o grupo fentanil apresentou degeneração significativa. .

JUSTIFICACIÓN: El objetivo de este estudio fue comparar los efectos neurotóxicos de la administración por vía intratecal de la levobupivacaína y el fentanilo y su mezcla sobre la médula espinal de ratones. MÉTODOS: El experimento abarcó 4 grupos que recibieron medicamento y un grupo control. Los ratones recibieron inyección de solución salina (15 µL) o fentanilo (0,0005 µg/15µL), levobupivacaína al 0,25% (15 µL) y fentanilo (0,0005 µg + levobupivacaína al 0,25%/15 µL) por vía intratecal durante 4 días. Se empleó el test de placa caliente para evaluar la función neurológica tras cada inyección en los minutos 5, 30 y 60. Cinco días después de la última inyección lumbar, se obtuvieron las secciones de la médula espinal entre los niveles vertebrales T5 y T6 para el análisis histológico. Usamos una puntuación basándonos en la evaluación subjetiva del número de neuronas eosinofílicas (neuronas rojas), lo que significa degeneración neuronal irreversible. Esas neuronas reflejan el número aproximado de neuronas en degeneración presentes en las áreas neuroanatómicas afectadas de la siguiente forma: 1 = ninguna; 2 = 1-20%; 3 = 21-40%; 4 = 41-60% y 5 = 61-100% neuronas muertas. Para cada ratón se calculó una puntuación neuropatológica global a través de la suma de las puntuaciones patológicas de todas las áreas examinadas de la médula espinal. RESULTADOS: En los resultados del test de placa caliente, comparando el grupo control, la latencia analgésica fue estadísticamente prolongada para los 4 grupos.En la inversión neuropatológica, los grupos fentanilo y fentanilo + levobupivacaína tuvieron una degeneración neuronal en recuentos significativamente más altos que los grupos control y salina. CONCLUSIONES: Esos resultados nos sugieren que el fentanilo y la levobupivacaína, cuando se administran por vía intratecal en ratones, se comportan de forma similar a la acción analgésica, pero el fentanilo puede ser neurotóxico para la médula espinal. No hubo ...

[Neurotoxic effects of levobupivacaine and fentanyl on rat spinal cord]. / Efeitos neurotóxicos de levobupivacaína e fentanil sobre a medula espinhal de ratos.

BACKGROUND: The purpose of the study was to compare the neurotoxic effects of intrathecally administered levobupivacaine, fentanyl and their mixture on rat spinal cord. METHODS: In experiment, there were four groups with medication and a control group. Rats were injected 15µL saline or fentanyl 0.0005µg/15µL, levobupivacaine 0.25%/15µL and fentanyl 0.0005µg+levobupivacaine 0.25%/15µL intrathecally for four days. Hot plate test was performed to assess neurologic function after each injection at 5th, 30th and 60th min. Five days after last lumbal injection, spinal cord sections between the T5 and T6 vertebral levels were obtained for histologic analysis. A score based on subjective assessment of number of eosinophilic neurons - Red neuron - which means irreversible neuronal degeneration. They reflect the approximate number of degenerating neurons present in the affected neuroanatomic areas as follows: 1, none; 2, 1-20%; 3, 21-40%; 4, 41-60%; and 5, 61-100% dead neurons. An overall neuropathologic score was calculated for each rat by summating the pathologic scores for all spinal cord areas examined. RESULTS: In the results of HPT, comparing the control group, analgesic latency statistically prolonged for all four groups. In neuropathologic investment, the fentanyl and fentanyl+levobupivacaine groups have statistically significant high degenerative neuron counts than control and saline groups. CONCLUSIONS: These results suggest that, when administered intrathecally in rats, fentanyl and levobupivacaine behave similar for analgesic action, but fentanyl may be neurotoxic for spinal cord. There was no significant degeneration with levobupivacaine, but fentanyl group has had significant degeneration.