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1.
Praxis (Bern 1994) ; 110(6): 324-335, 2021 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-33906439

RESUMO

Acute Traumatic Central Cord Syndrome: Etiology, Pathophysiology, Clinical Manifestation, and Treatment Abstract. The acute traumatic central cord syndrome (ATCCS) represents an injury to the spinal cord with disproportionately greater motor impairment of the upper than the lower extremities, with bladder dysfunction and with varying degrees of sensory loss below the level of the respective lesion. The mechanism of ATCCS is most commonly a traumatic hyperextension injury of the cervical spine at the base of an underlying spondylosis and spinal stenosis. The mean age is 53 years, and segments C4 to Th1 are most frequently affected. In addition to medical history and clinical examination, the definitive diagnosis is made by magnetic resonance imaging, where T2-hyperintense lesions are typically observed in the affected spinal cord segment. Surgical decompression (and fusion) of the respective segment is recommended to prevent repetitive trauma to the spinal cord and to stop progression of clinical symptoms. Patients with diagnosed ATCCS and who are treated adequately usually have a good prognosis.


Assuntos
Síndrome Medular Central , Traumatismos da Medula Espinal , Estenose Espinal , Síndrome Medular Central/diagnóstico , Síndrome Medular Central/etiologia , Síndrome Medular Central/terapia , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Descompressão Cirúrgica , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Traumatismos da Medula Espinal/cirurgia , Estenose Espinal/diagnóstico , Estenose Espinal/etiologia , Estenose Espinal/cirurgia
2.
Life Sci ; 276: 119441, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-33794257

RESUMO

AIM: Ligature tightness of chronic constriction injury (CCI) model remains inconsistent and controversial, presenting barriers for researchers. METHODS: We summarized the different ligation criteria in literature and attempted to clarify their effects. To assess constriction under different criteria, we calculated the radial strain (εR) of ligated nerves from digital photographs. The mechanical withdrawal thresholds (MWT), thermal withdrawal latency (TWL) and sciatic functional index (SFI) were observed in rats of different groups to assess the state of model. Changes of myelin sheath were detected by pathological staining and immunohistochemistry. RESULTS: The median εR values in the Loose, Medium and Tight groups were 13.6%, 15.2% and 21.7%, respectively. Ligated groups had lower MWT than Sham group and the TWL of rats in the Loose approached to rats with sham operation, while that of the Tight group was higher than Medium group 14 days after surgery. Medium and Tight groups showed more abnormal in SFI, compared with the other two groups 14 days. Pathological staining revealed demyelination in three CCI groups, especially in the sciatic nerves. Myelin protein zero levels decreased in the sciatic nerves as the degree of constriction increased, but myelin basic protein of the Medium group was lowest abundant in the spinal cords of all rats. CONCLUSIONS: Our study demonstrated that the surrounding muscles briefly twitched when the diameter of the sciatic nerves was constricted by approximately 14-15%, which may provide a reference for other researchers for establishing CCI models.


Assuntos
Lesões por Esmagamento/complicações , Neuralgia/patologia , Nervo Isquiático/lesões , Traumatismos da Medula Espinal/complicações , Animais , Constrição , Lesões por Esmagamento/cirurgia , Ligadura , Masculino , Neuralgia/etiologia , Ratos , Ratos Sprague-Dawley , Nervo Isquiático/cirurgia , Traumatismos da Medula Espinal/cirurgia
3.
Medicine (Baltimore) ; 100(2): e24096, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33466175

RESUMO

RATIONALE: We report the first case of the management of spinal cord transection due to thoracolumbar fracture-dislocation in human beings. There are several case reports of cord transection, but only radiological findings have been reported; we report intraoperative findings and management. PATIENT CONCERNS: A 53-year-old man presented to the hospital after falling. He had no motor power or sensation below T10 (below the umbilicus area) dermatome level. American Spinal Injury Association (ASIA) impairment scale was grade A. Magnetic resonance imaging and computed tomography demonstrated a fracture and translation of the vertebral body at the T11-T12 level and anterior displacement of T11 on T12, with complete disruption of the spinal cord. DIAGNOSIS: Complete spinal cord resection due to T11-T12 fracture-dislocation. INTERVENTIONS: We performed spinal fusion with pedicle screw instrumentation (T10-L1) and autobone graft and decompression and repaired the dural sac to prevent cerebrospinal fluid leakage. There was no neurological recovery either immediately or 4 years post-operation at follow-up. CONCLUSION: To the best of our knowledge, this report is the first on the intraoperative finding and management of the complete transection of the spinal cord in thoracolumbar spine injury. Perfect fusion is required to facilitate rehabilitation and daily living, prevent neurogenesis, and prevent unnecessary pain such as phantom pain.


Assuntos
Fratura-Luxação/cirurgia , Traumatismos da Medula Espinal/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Fusão Vertebral/métodos , Vértebras Torácicas/lesões , Fratura-Luxação/complicações , Humanos , Achados Incidentais , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Parafusos Pediculares , Traumatismos da Medula Espinal/diagnóstico , Fraturas da Coluna Vertebral/complicações , Vértebras Torácicas/cirurgia
4.
Spine (Phila Pa 1976) ; 46(1): E31-E36, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33065692

RESUMO

STUDY DESIGN: Retrospective study. OBJECTIVE: A retrospective study was conducted to clarify the prognostic factors of postoperative for cervical spine fractures patients with ankylosing spondylitis (AS). SUMMARY OF BACKGROUND DATA: Now the high probability of cervical fractures in patients with AS is unanimously recognized. Fractures mostly occur in the lower cervical spine and two-thirds of patients are accompanied by spinal cord injury. But there are few studies on treatment of AS patients with cervical fracture and it is unclear whether the surgical method, timing of surgery, basic treatment of AS, and different doses of steroids therapy have an impact on the prognosis. Thus, this study aims to evaluate the impact of perioperative factors on the prognosis of traumatic cervical fractures in surgical patients with AS. METHODS: Preoperative and postoperative spinal cord function were assessed according to the Japanese Orthopaedic Association (JOA) Scores and Improvement rate were calculated. The neck pain severity were rated using a visual analogue scale (VAS) score. The t test and v2-test were used for comparison of clinical data between the preoperative and postoperative groups. Logistic univariate and multivariate regression analysis were used to obtain adjusted odds ratios. Pearson correlation coefficients were used to evaluate the relationship between variables. RESULTS: The degree of fracture displacement in cervical spine fractures patients with AS was most common at the neck-chest junction (26.1%). Patients with degree of cervical fracture displacement less than 50% had significantly improved JOA scores after surgery (P = 0). The incidence of spinal cord injury (SCI) due to fracture was high (52.2%). Patients with combined anterior and posterior is helpful for neurological recovery (P = 0.01). Basic AS treating before injury would be benefit for neurological improvement (P = 0). CONCLUSION: Basic AS treatment, SCI, and surgical methods are independent factors that affect the prognosis of cervical spine fractures patients with AS. It is controversial to perform surgery and preoperative steroid application as soon as possible. LEVEL OF EVIDENCE: 3.


Assuntos
Vértebras Cervicais/cirurgia , Fraturas Ósseas/cirurgia , Espondilite Anquilosante/cirurgia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Lesões do Pescoço/complicações , Estudos Retrospectivos , Traumatismos da Medula Espinal/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Resultado do Tratamento
6.
Lancet Neurol ; 20(2): 117-126, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33357514

RESUMO

BACKGROUND: Although there is a strong biological rationale for early decompression of the injured spinal cord, the influence of the timing of surgical decompression for acute spinal cord injury (SCI) remains debated, with substantial variability in clinical practice. We aimed to objectively evaluate the effect of timing of decompressive surgery for acute SCI on long-term neurological outcomes. METHODS: We did a pooled analysis of individual patient data derived from four independent, prospective, multicentre data sources, including data from December, 1991, to March, 2017. Three of these studies had been published; of these, only one study previously specifically analysed the effect of the timing of surgical decompression. These four datasets were selected because they were among the highest quality acute SCI datasets available and contained highly granular data. Individual patient data were obtained by request from study authors. All patients who underwent decompressive surgery for acute SCI within these datasets were included. Patients were stratified into early (<24 h after spinal injury) and late (≥24 h after spinal injury) decompression groups. Neurological outcomes were assessed by American Spinal Injury Association (ASIA), or International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), examination. The primary endpoint was change in total motor score from baseline to 1 year after spinal injury. Secondary endpoints were ASIA Impairment Scale (AIS) grade and change in upper-extremity motor, lower-extremity motor, light touch, and pin prick scores after 1 year. One-stage meta-analyses were done by hierarchical mixed-effects regression adjusting for baseline score, age, mechanism of injury, AIS grade, level of injury, and administration of methylprednisolone. Effect sizes were summarised by mean difference (MD) for sensorimotor scores and common odds ratio (cOR) for AIS grade, with corresponding 95% CIs. As a secondary analysis, change in total motor score was regressed against time to surgical decompression (h) as a continuous variable, using a restricted cubic spline with adjustment for the same covariates as in the primary analysis. FINDINGS: We identified 1548 eligible patients from the four datasets. Outcome data at 1 year after spinal injury were available for 1031 patients (66·6%). Patients who underwent early surgical decompression (n=528) experienced greater recovery than patients who had late decompression surgery (n=1020) at 1 year after spinal injury; total motor scores improved by 23·7 points (95% CI 19·2-28·2) in the early surgery group versus 19·7 points (15·3-24·0) in the late surgery group (MD 4·0 points [1·7-6·3]; p=0·0006), light touch scores improved by 19·0 points (15·1-23·0) vs 14·8 points (11·2-18·4; MD 4·3 [1·6-7·0]; p=0·0021), and pin prick scores improved by 18·3 points (13·7-22·9) versus 14·2 points (9·8-18·6; MD 4·0 [1·5-6·6]; p=0·0020). Patients who had early decompression also had better AIS grades at 1 year after surgery, indicating less severe impairment, compared with patients who had late surgery (cOR 1·48 [95% CI 1·16-1·89]; p=0·0019). When time to surgical decompression was modelled as a continuous variable, there was a steep decline in change in total motor score with increasing time during the first 24-36 h after injury (p<0·0001); and after 36 h, change in total motor score plateaued. INTERPRETATION: Surgical decompression within 24 h of acute SCI is associated with improved sensorimotor recovery. The first 24-36 h after injury appears to represent a crucial time window to achieve optimal neurological recovery with decompressive surgery following acute SCI. FUNDING: None.


Assuntos
Descompressão Cirúrgica/métodos , Procedimentos Neurocirúrgicos/métodos , Traumatismos da Medula Espinal/cirurgia , Adolescente , Adulto , Anti-Inflamatórios/uso terapêutico , Vértebras Cervicais/cirurgia , Avaliação da Deficiência , Determinação de Ponto Final , Feminino , Humanos , Masculino , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Transtornos dos Movimentos/etiologia , Estudos Prospectivos , Recuperação de Função Fisiológica , Sensação , Tempo para o Tratamento , Resultado do Tratamento , Adulto Jovem
7.
Exp Cell Res ; 398(2): 112418, 2021 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-33309808

RESUMO

BACKGROUND: NIMA-related kinase-7 (NEK7) is a serine/threonine kinase that drives cell-cycle dynamics by modulating mitotic spindle formation and cytokinesis. It is also a crucial modulator of the pro-inflammatory effects of NOD-like receptor 3 (NLRP3) inflammasome. However, the role of NEK7 in microglia/macrophages post-spinal cord injury (SCI) is not well defined. METHODS: In this study, we performed both in vivo and in vitro experiments. Using an in vivo mouse SCI model, NEK7 siRNAs were administered intraspinally. For in vitro analysis, BV-2 microglia cells with NEK7-siRNA were stimulated with 1 µg/ml lipopolysaccharide (LPS) and 2 mM Adenosine triphosphate (ATP). RESULTS: Here, we found that the mRNA and protein levels of NEK7 and NLRP3 inflammasomes were upregulated in spinal cord tissues of injured mice and BV-2 microglia cells exposed to Lipopolysaccharide (LPS) and Adenosine triphosphate (ATP). Further experiments established that NEK7 and NLRP3 interacted in BV-2 microglia cells, an effect that was eliminated following NEK7 ablation. Moreover, NEK7 ablation suppressed the activation of NLRP3 inflammasomes. Although NEK7 inhibition did not significantly improve motor function post-SCI in mice, it was found to attenuate local inflammatory response and inhibit the activation of NLRP3 inflammasome in microglia/macrophages of the injured spinal cord. CONCLUSION: NEK7 amplifies NLRP3 inflammasome pro-inflammatory signaling in BV-2 microglia cells and mice models of SCI. Therefore, agents targeting the NEK7/NLRP3 signaling offers great promise in the treatment of inflammatory response post-SCI.


Assuntos
Inflamassomos/metabolismo , Macrófagos/metabolismo , Microglia/metabolismo , Quinases Relacionadas a NIMA/metabolismo , Proteína 3 que Contém Domínio de Pirina da Família NLR/metabolismo , Traumatismos da Medula Espinal/metabolismo , Trifosfato de Adenosina/farmacologia , Animais , Células Cultivadas , Modelos Animais de Doenças , Feminino , Lipopolissacarídeos/farmacologia , Macrófagos/efeitos dos fármacos , Camundongos , Camundongos Endogâmicos C57BL , Microglia/efeitos dos fármacos , RNA Mensageiro/metabolismo , Transdução de Sinais/efeitos dos fármacos , Traumatismos da Medula Espinal/cirurgia
8.
Zhongguo Gu Shang ; 33(12): 1128-33, 2020 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-33369320

RESUMO

OBJECTIVE: To explore the effect of anterolateral spinal canal decompression combined with short segment screw fixation with posterior approach for severe thoracolumbar burst fractures with spinal cord injury. METHODS: From January 2016 to June 2018, 16 patients with severe thoracolumbar burst fractures (more than 50% of ratio of spinal canal encroachment, reverse fragment at the posterior edge of the vertebral body) with spinal cord injury were retrospectively analyzed, including 10 males and 6 females, ranging in age from 19 to 57 years old. Causes of injury:8 cases of fall injury, 6 cases of traffic accident injury and 2 cases of other injuries. Fracture site:T11 in 4 cases, T12 in 5 cases, L1 in 5 cases, L2 in 2 cases. All the patients underwent anterolateral spinal canal decompression combined with short segment screw fixation with posterior approach. The curative imaging effects were evaluated by measuring the loss height of the anterior edge of the injured vertebra, Cobb angle of the adjacent segment of the injured vertebra, and ratio of spinal canal encroachment. The clinical effects were evaluated by Frankel spinal cord injury rating and visual analogue scale (VAS). RESULTS: All 16 patients were followed up, and the average follow up time was (15.9±5.4) months. The average operation time was (234±41) minutes and the average amount of bleeding was (431±93) ml. The loss of anterior height of injured vertebrae was (52.25±10.10)% before operation, (8.93± 3.61)% at 3 days after operation, and (9.25±2.88)% at the latest follow up. The results of 3 days after operation and the latest follow up were better than that before operation, and there was no significant differencesbetween results at the latest follow up and 3 days after operation (P<0.01). Cobb angle of adjacent segment of injured vertebrae was (28.19±10.89)°before operation, (5.31±5.14)° 3 days after operation, and (6.81±4.59)°at the latest follow-up. The ratio of spinal canal encroachment was (67.68±12.45)% before operation, (7.69±4.46)% at 3 days after operation, and (4.75±1.63)% at the latest follow-up. At 3 days and the latest follow-up, the rate recovered to a certain extent (P<0.05). At the latest follow up, spinal nerve function was improved in 12 patients, no improvement in 4 patients and no deterioration in nerve function. VSA score was improved from preoperative 7.8±0.9 to final follow-up 1.8±0.7. CONCLUSION: For severe thoracolumbar burst fracture and spinal cord injury, with more than 50% of ratio of spinal canal encroachment and reverse fragment at the posterior edge of the vertebral body, the anterolateral spinal canal decompression combined with short segment screw fixation with posterior approach has the characteristics of accurate reduction, complete decompression and firm fixation, and the clinical effect is satisfactory.


Assuntos
Traumatismos da Medula Espinal , Fraturas da Coluna Vertebral , Adulto , Parafusos Ósseos , Descompressão , Feminino , Fixação Interna de Fraturas , Humanos , Vértebras Lombares/lesões , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Canal Vertebral , Traumatismos da Medula Espinal/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/lesões , Vértebras Torácicas/cirurgia , Resultado do Tratamento , Adulto Jovem
10.
J Am Acad Orthop Surg ; 28(17): 707-716, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32833389

RESUMO

INTRODUCTION: Traumatic spinal cord injury (SCI) is a life-altering event. Motor vehicle accidents and falls are common causes of traumatic SCI, and SCI outcomes may be affected by patients' ages and injury sites. This study aimed to investigate the factors associated with unfavorable in-hospital outcomes, focusing on the impact of patients' ages and SCI lesion sites. METHODS: Data of 25,988 patients hospitalized with traumatic SCI in the US National Inpatient Sample (NIS) database from 2005 to 2014 were extracted and analyzed. Univariate and multivariate logistic regression analyses were performed to determine the factors associated with SCI outcomes, including in-hospital deaths, adverse discharge, and prolonged hospital stays. RESULTS: Multivariate analysis revealed that the oldest ages (>65 years) were significantly associated with increased in-hospital mortality compared with the youngest ages at all lesion sites (cervical, odds ratio [OR]: 5.474, 95% confidence interval [CI]: 4.465 to 6.709; thoracic, OR: 5.940, 95% CI: 3.881 to 9.091; and lumbosacral, OR: 6.254, 95% CI: 2.920 to 13.394). Older ages were also significantly associated with increased adverse outcomes at all sites (cervical, OR: 2.460, 95% CI: 2.180 to 2.777; thoracic, OR: 2.347, 95% CI: 1.900 to 2.900; and lumbosacral, OR: 2.743, 95% CI: 2.133 to 3.527). Intermediate ages (35 to 64) were also significantly associated with increased in-hospital death and adverse discharge at cervical and thoracic SCIs, but not at lumbosacral sites. DISCUSSION: For hospitalized patients with traumatic SCI, older age independently predicts worse in-hospital outcomes, with greatest effects seen in patients aged 65 years and older. Study findings suggest that extra vigilance and targeted management strategies are warranted in managing SCI patients aged 65 years and older during hospitalization.


Assuntos
Bases de Dados Factuais , Avaliação de Resultados em Cuidados de Saúde/métodos , Traumatismos da Medula Espinal/mortalidade , Traumatismos da Medula Espinal/cirurgia , Acidentes por Quedas , Acidentes de Trânsito , Adulto , Fatores Etários , Idoso , Vértebra Cervical Áxis , Feminino , Mortalidade Hospitalar , Humanos , Pacientes Internados , Tempo de Internação , Modelos Logísticos , Região Lombossacral , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Vértebras Torácicas , Estados Unidos , Adulto Jovem
11.
J Vis Exp ; (160)2020 06 17.
Artigo em Inglês | MEDLINE | ID: mdl-32628176

RESUMO

We describe the implementation of spinal cord injury in mice to elicit detrusor-sphincter dyssynergia, a functional bladder outlet obstruction, and subsequent bladder wall remodeling. To facilitate assessment of the cellular composition of the bladder wall in non-injured control and spinal cord injured mice, we developed an optimized dissociation protocol that supports high cell viability and enables the detection of discrete subpopulations by flow cytometry. Spinal cord injury is created by complete transection of the thoracic spinal cord. At the time of tissue harvest, the animal is perfused with phosphate-buffered saline under deep anesthesia and bladders are harvested into Tyrode's buffer. Tissues are minced prior to incubation in digestion buffer that has been optimized based on the collagen content of mouse bladder as determined by interrogation of publicly available gene expression databases. Following generation of a single cell suspension, material is analyzed by flow cytometry for assessment of cell viability, cell number and specific subpopulations. We demonstrate that the method yields cell populations with greater than 90% viability, and robust representation of cells of mesenchymal and epithelial origin. This method will enable accurate downstream analysis of discrete cell types in mouse bladder and potentially other organs.


Assuntos
Separação Celular/métodos , Traumatismos da Medula Espinal/patologia , Bexiga Urinária/patologia , Animais , Calibragem , Sobrevivência Celular , Análise de Dados , Matriz Extracelular/metabolismo , Feminino , Citometria de Fluxo , Camundongos , Perfusão , Traumatismos da Medula Espinal/cirurgia , Transcriptoma/genética
12.
J Urol ; 204(6): 1263-1269, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32614256

RESUMO

PURPOSE: Management of pregnancy and delivery in women with lower urinary tract reconstruction is challenging and the currently available literature is insufficient to guide clinical practice. We report pregnancy and delivery outcomes in this specific population. MATERIALS AND METHODS: We conducted a national multicenter retrospective study (16 centers) including 68 women with 96 deliveries between 1998 and 2019. These women had at least 1 successful pregnancy and delivery after augmentation enterocystoplasty, catheterizable channel creation and/or artificial urinary sphincter implantation. Maternal and fetal complications during pregnancy and delivery were reported, as well as postpartum functional outcomes, according to the delivery mode. The chi-square test and Student's t-test were used to compare categorical and continuous variables, respectively. RESULTS: Overall 32% of reported pregnancies were complicated by febrile urinary tract infections, 13.5% by renal colic and 14.6% required upper urinary tract diversion. In addition, 10% of patients reported transient self-catheterization difficulties and 13.5% reported de novo or increased urinary incontinence. The preterm delivery rate was 35.3%. Elective C-section was performed in 61% of pregnancies. Twenty complications occurred during delivery (20%), including 19 during elective C-section. Urinary continence at 1 year was unchanged for 93.5% of deliveries. Delivery mode (p=0.293) and multiparity (p=0.572) had no impact on urinary continence. CONCLUSIONS: In this population C-section appeared to be associated with a high risk of complications. In the absence of any obstetric or neurological contraindications, vaginal delivery should be proposed as the first line option to the majority of these women.


Assuntos
Cesárea/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Adolescente , Adulto , Cesárea/estatística & dados numéricos , Feminino , França/epidemiologia , Humanos , Esclerose Múltipla/cirurgia , Complicações Pós-Operatórias/etiologia , Gravidez , Complicações na Gravidez/etiologia , Complicações na Gravidez/cirurgia , Nascimento Prematuro/etiologia , Cólica Renal/epidemiologia , Cólica Renal/etiologia , Estudos Retrospectivos , Traumatismos da Medula Espinal/cirurgia , Disrafismo Espinal/cirurgia , Bexiga Urinária/anormalidades , Bexiga Urinária/cirurgia , Derivação Urinária/estatística & dados numéricos , Incontinência Urinária/epidemiologia , Incontinência Urinária/etiologia , Esfíncter Urinário Artificial/efeitos adversos , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia , Adulto Jovem
13.
Medicine (Baltimore) ; 99(29): e21188, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702880

RESUMO

Retrospective single institution observational study.The aim of the present study was to analyze the influence of early extensive posterior decompression on complications in patients with severe traumatic cervical spinal cord injury (tcSCI).Cervical SCI is associated with a high prevalence of hyponatremia and cardiopulmonary dysfunction. However, very few studies have focused on this exploration to reduce the incidence of SCI early complications.We reviewed the medical records of consecutive patients undergoing extensive posterior decompression within 24 h for severe tcSCI (American Spinal Injury Association Impairment Scale [AIS] A to C) admitted between January 2009 and January 2018. The data collected retrospectively included age, gender, mechanism, and level of SCI, AIS grade, fracture or dislocation, electrolyte, and cardiopulmonary complications.Of the 97 enrolled patients, the baseline AIS grade was AIS A in 14, AIS B in 31, and AIS C in 52. Improvement of at least two AIS grades was found in 26 (26.8%), and improvement of at least one grade was found in 80.4% of patients at discharge. Twenty-nine (29.9%) patients had mild hyponatremia, 8 (8.2%) had moderate hyponatremia, and 3 (3.1%) had severe hyponatremia during hospitalization. The incidences of hyponatremia, hypotension, and tracheotomy were 41.2%, 13.4%, and 6.2%, respectively. The mean forced vital capacity (FVC) on admission and at discharge was 1.34 ±â€Š0.46 L and 2.21 ±â€Š0.41 L (P < .0001), respectively. Five patients developed pneumonia.Our results suggest that early expansive posterior decompression significantly reduces the incidence of hyponatremia, hypotension, and tracheotomy by promoting recovery of spinal cord function after severe tcSCI.


Assuntos
Medula Cervical/fisiopatologia , Descompressão Cirúrgica/reabilitação , Hiponatremia/etiologia , Traumatismos da Medula Espinal/cirurgia , Disfunção Ventricular/etiologia , Adulto , Medula Cervical/lesões , Medula Cervical/cirurgia , Descompressão Cirúrgica/métodos , Descompressão Cirúrgica/estatística & dados numéricos , Feminino , Humanos , Hiponatremia/sangue , Hiponatremia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Estudos Retrospectivos , Traumatismos da Medula Espinal/sangue , Traumatismos da Medula Espinal/fisiopatologia , Resultado do Tratamento , Disfunção Ventricular/fisiopatologia
15.
J Vis Exp ; (159)2020 05 06.
Artigo em Inglês | MEDLINE | ID: mdl-32449707

RESUMO

Spinal cord injury (SCI) largely leads to irreversible and permanent loss of function, most commonly as a result of trauma. Several treatment options, such as cell transplantation methods, are being researched to overcome the debilitating disabilities arising from SCI. Most pre-clinical animal trials are conducted in rodent models of SCI. While rat models of SCI have been widely used, mouse models have received less attention, even though mouse models can have significant advantages over rat models. The small size of mice equates to lower animal maintenance costs than for rats, and the availability of numerous transgenic mouse models is advantageous for many types of studies. Inducing repeatable and precise injury in the animals is the primary challenge for SCI research, which in small rodents requires high-precision surgery. The transection-type injury model has been a commonly used injury model over the last decade for transplantation-based therapeutic research, however a standardized method for inducing a complete transection-type injury in mice does not exist. We have developed a surgical protocol for inducing a complete transection type injury in C57BL/6 mice at thoracic vertebral level 10 (T10). The procedure uses a small tip drill instead of rongeurs to precisely remove the lamina, after which a thin blade with rounded cutting edge is used to induce the spinal cord transection. This method leads to reproducible transection-type injury in small rodents with minimal collateral muscle and bone damage and therefore minimizes confounding factors, specifically where behavioral functional outcomes are analyzed.


Assuntos
Traumatismos da Medula Espinal/patologia , Pontos de Referência Anatômicos , Animais , Modelos Animais de Doenças , Feminino , Laminectomia , Camundongos Endogâmicos C57BL , Traumatismos da Medula Espinal/cirurgia
17.
Orthop Surg ; 12(2): 570-581, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32347006

RESUMO

OBJECTIVE: To evaluate the feasibility and safety of cervical kinematic MRI (KMRI) in patients with cervical spinal cord injury without fracture and dislocation (CSCIWFD). METHODS: This was a single-institution case-only study. Patients with CSCIWFD were enrolled in our institution from February 2015 to July 2019. Cervical radiography and CT were performed first to exclude cervical tumors, and major fracture or dislocation. Then neutral static and kinematic (flexion and extension) MRI was performed for patients who met the inclusion criteria under the supervision of a spinal surgeon. Any adverse events during the KMRI examination were recorded. Patients received surgical or conservative treatment based on the imaging results and patients' own wishes. The American Spinal Injury Association impairment scale (AIS) grade and the Japanese Orthopedic Association (JOA) score were evaluated on admission, before KMRI examination, and after KMRI examination. For the surgical patients, AIS grade and JOA score were evaluated again 1 week after the operation. The JOA scores were compared among different time points using the paired t-test. RESULTS: A total of 16 patients (12 men and 4 women, mean age: 51.1 [30-73] years) with CSCIWFD were included in the present study. Clinical symptoms included facial trauma, neck pain, paraplegia, paresthesia, hyperalgesia, sensory loss or weakness below the injury level, and dyskinesia. On admission, AIS grades were B for 2 cases, C for 5, and D for 9. A total of 14 patients underwent neutral, flexion, and extension cervical MRI examination; 2 patients underwent neutral and flexion examination because they could not maintain the position for a prolonged duration. No patient experienced deterioration of neurological function after the examinations. The AIS grades and JOA scores evaluated post-examination were similar to those evaluated pre-examination (P > 0.05) and significantly higher than those on admission (P < 0.05). A total of 12 patients received surgical treatment, 11 of whom underwent anterior cervical discectomy and interbody fusion and 1 underwent posterior C3/4 fusion with lateral mass screws. The remaining 4 patients were offered conservative therapy. None of the patients experienced any complications during the perioperative period. The AIS grade did not change in most surgical patients, except that 1 patient changed from grade C to D 1 week after the operation. The JOA score 1 week after surgery was significantly higher than those on admission and around examination for the surgical patients (P < 0.05). CONCLUSION: Cervical KMRI is a safe and useful technique for diagnosis of CSCIWFD, which is superior to static cervical MRI for therapeutic decision-making in patients with CSCIWFD.


Assuntos
Medula Cervical/diagnóstico por imagem , Medula Cervical/lesões , Imagem por Ressonância Magnética , Traumatismos da Medula Espinal/diagnóstico por imagem , Adulto , Idoso , Fenômenos Biomecânicos , Medula Cervical/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos da Medula Espinal/cirurgia
18.
Vet Surg ; 49(5): 884-893, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32277768

RESUMO

OBJECTIVE: To report recovery of ambulation of dogs treated with extended thoracolumbar durotomy for severe spinal cord injury caused by intervertebral disc herniation. STUDY DESIGN: Descriptive cohort. ANIMALS: Twenty-six consecutive paraplegic dogs presented with loss of deep pain sensation after acute thoracolumbar intervertebral disc herniation. METHODS: Each dog underwent routine diagnostic assessment and surgery for removal of extradural herniated intervertebral disc, followed by a four-vertebral body length durotomy centered on the herniated disc. Each dog was followed up until it was able to walk 10 steps without assistance or until 6 months after surgery. RESULTS: Sixteen of 26 dogs recovered to walk unaided (all but one also recovered fecal and urinary continence), and six dogs did not; four dogs were lost to follow-up. One dog was euthanized because of signs consistent with progressive myelomalacia. There was no evidence of detrimental effects of durotomy within the period of study. Using Bayesian analysis, we found a point estimate of successful outcome of 71% with 95% credible interval from 52% to 87%. CONCLUSION: Extended durotomy seemed to improve the outcome of dogs in our case series without increase in morbidity. CLINICAL SIGNIFICANCE: Extended durotomy appears safe and may improve the outcome of dogs with severe thoracolumbar mixed contusion and compressive injuries associated with acute intervertebral disc extrusion.


Assuntos
Doenças do Cão/cirurgia , Dura-Máter/cirurgia , Deslocamento do Disco Intervertebral/veterinária , Traumatismos da Medula Espinal/veterinária , Animais , Estudos de Coortes , Cães , Feminino , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/cirurgia , Masculino , Traumatismos da Medula Espinal/etiologia , Traumatismos da Medula Espinal/cirurgia
19.
N Z Med J ; 133(1509): 47-57, 2020 02 07.
Artigo em Inglês | MEDLINE | ID: mdl-32027638

RESUMO

AIM: To investigate the epidemiology of traumatic spinal cord injury (TSCI) in New Zealand over a 10-year period. METHODS: Ambispective data of all new patients admitted to New Zealand's two spinal rehabilitation units between January 2007 and December 2016 (n=929) were collated. Variables assessed included age at injury, gender, ethnicity, date of injury, aetiology, length of hospital stay, injury level, neurological status on discharge and discharge destination. RESULTS: The incidence of TSCI averaged 22 (95% CI 21-24) per million, increasing 6% a year. The average incidence for Maori (29 per million people (95% CI 25-34)) was 1.8 times higher than New Zealand European (16 per million people (95% CI 15-18)), and show an increase of 14% a year. The median age of TSCI increased from 43 to 48 years. Overall, falls (32%), transport (32%) and sports (22%) were the most common causes of TSCI. Cervical TSCI (54%) were most common, particularly in older adults (70% over 75 years) and Maori (61%) and Pacific Island (72%) patients. Surgical rates remained stable (77%) but length of stay in hospital decreased over the study period. CONCLUSIONS: The demographic of TSCI is changing in New Zealand. The median age of patients is increasing, as is the incidence, particularly for women, older adults and Maori patients.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Acidentes de Trânsito/estatística & dados numéricos , Traumatismos em Atletas/epidemiologia , Traumatismos da Medula Espinal/epidemiologia , Violência/estatística & dados numéricos , Atividades Cotidianas , Adolescente , Adulto , Distribuição por Idade , Idoso , Vértebras Cervicais , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Incidência , Tempo de Internação/estatística & dados numéricos , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Nova Zelândia/epidemiologia , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Sistema de Registros , Distribuição por Sexo , Traumatismos da Medula Espinal/etnologia , Traumatismos da Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/cirurgia , Vértebras Torácicas , Adulto Jovem
20.
Am J Phys Med Rehabil ; 99(8): 712-718, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32032092

RESUMO

OBJECTIVE: The aim of the study was to investigate the impact of the absence of a bulbocavernosus reflex in the postoperative period on the neurological and functional recovery 6-12 mos after a motor-complete traumatic spinal cord injury. DESIGN: A retrospective review of a prospective database was completed among 66 patients. The functional and neurological statuses between individuals with and without a bulbocavernosus reflex were compared. A general linear model was used to investigate the association between the postoperative bulbocavernosus reflex status and the functional outcome, using the Spinal Cord Independence Measure. RESULTS: Forty percent of the cohort had no bulbocavernosus reflex 5 days after trauma. Individuals with a bulbocavernosus reflex showed a higher rate of American Spinal Injury Association Impairment Scale grade conversion, improvement of the level of injury, and higher functional scores; however, it did not reach a significant level. The bulbocavernosus reflex status in the postoperative period was not significantly associated with the functional status 6-12 mos after injury. CONCLUSIONS: Late recovery of the bulbocavernosus reflex in the postoperative period may be associated with poorer neurological and functional outcome for individuals sustaining a motor-complete traumatic spinal cord injury, for which the prognosis estimation is limited. A prospective study including a larger number of patients is necessary to confirm results of this study.


Assuntos
Recuperação de Função Fisiológica/fisiologia , Reflexo Anormal/fisiologia , Traumatismos da Medula Espinal/fisiopatologia , Escala Resumida de Ferimentos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos , Traumatismos da Medula Espinal/cirurgia
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