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Verma V, Regmi A, Jain A, Shekhar Sethy S, Kandwal P, Sarkar B. Correlation between MRI and DTI parameters in acute thoracic spinal cord injury and clinical outcomes: A prospective observational study. J Clin Orthop Trauma 2025; 66:102975. [PMID: 40292391 PMCID: PMC12032308 DOI: 10.1016/j.jcot.2025.102975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2024] [Revised: 03/06/2025] [Accepted: 03/12/2025] [Indexed: 04/30/2025] Open
Abstract
Study design Prospective Observational Study. Objective The current study aims to explore the correlation of MRI and DTI parameters in acute thoracic spinal cord injuries for prediction of neurological outcomes. Setting University level tertiary care hospital of Northern India. Methods Conventional MRI and DTIs were performed for 51 acute thoracic spinal cord injury patients. The relationship of MRI and DTI parameters with preoperative and postoperative AIS motor and sensory scores in complete and incomplete neurological deficit groups were done. AIS score, AO PROST Score and ODI score was used for neurological and functional assessment of spinal cord functions. Patients were divided into group I (ASIA A) and Group II (ASIA B, C, D). MRI and DTI parameters were compared between groups for their predictive value on neurology at admission and at final follow up. Results Out of 20 patients in group I, 3 patients recovered by grade 1 and 6 patients by grade 2 and no recovery in 11 patients. In group II out of 31 patients 10 patients (33.4 %) recovered to ASIA E neurology. On Univariate analysis MOCC, SCC, Length of Cord swelling, LOE, Distortion index, Type of injury and Hematomyelia were significantly associated with complete neurological deficit at presentation. However, on final follow up, MOCC, SCC, Length of cord edema, and Hematomyelia were significant in predicting neurology. Conclusion Maximum osseous canal compromise, Spinal Cord Compression, Length of Edema, Length of Spinal cord swelling, and hematomyelia are best correlated with prediction of a neurological deficit. DTI also provides superior spinal cord imaging but faces technical challenges. Level of evidence III.
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Affiliation(s)
- Vishal Verma
- Department of Orthopedics, AIIMS, Rishikesh, Uttarakhand, 249203, India
| | - Anil Regmi
- Department of Orthopedics, AIIMS, Rishikesh, Uttarakhand, 249203, India
| | - Aakash Jain
- Department of Orthopedics, AIIMS, Rishikesh, Uttarakhand, 249203, India
| | | | - Pankaj Kandwal
- Department of Orthopedics, AIIMS, Rishikesh, Uttarakhand, 249203, India
| | - Bhaskar Sarkar
- Department of Trauma Surgery, AIIMS, Rishikesh, Uttarakhand, 249203, India
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Asif H, Visagan R, Boseta E, Zoumprouli A, Papadopoulos MC, Saadoun S. Evolution of Spinal Cord Swelling in Acute Traumatic Spinal Cord Injury. Neurotrauma Rep 2025; 6:158-170. [PMID: 40129896 PMCID: PMC11931111 DOI: 10.1089/neur.2025.0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2025] Open
Abstract
We hypothesized that the Monro-Kellie doctrine, a key principle in traumatic brain injury (TBI), also applies in traumatic spinal cord injury (TSCI). By analyzing 9986 h of intraspinal pressure (ISP) monitoring data from 79 TSCI patients, we show that concepts developed to quantify compensatory reserve in TBI may be analogously defined in TSCI, termed ISP pulse amplitude (sAMP), spinal compensatory reserve index (sRAP), and ISP waveform shape. As ISP increases beyond 15 mmHg, compensatory reserve becomes impaired (sAMP rises and sRAP becomes positive). As ISP increases beyond 20 mmHg, the morphology of the ISP waveform changes from three peaks (P1, P2, P3) with P1 dominant, to three peaks with P2 dominant, to a rounded signal. Key differences in TSCI, compared with TBI, are no plateau ISP waves, and no critical ISP beyond which sAMP decreases and sRAP becomes negative. Four factors were associated with increased spinal cord swelling or reduced spinal cord compliance: thoracic level of injury, no laminectomy, delayed surgery, and more severe injury. We also hypothesized that, as in TBI, the spinal cord maximally swells a few days after injury. Serial ultrasound scans of the injured spinal cords in 9 patients and plots of change from baseline in ISP, sAMP, and sRAP versus time in 79 patients revealed delayed maximal cord swelling within 5 days of surgery. We conclude that the spinal Monro-Kellie concept allows the spinal compensatory reserve to be quantified. Our data show that spinal compensatory reserve becomes exhausted as ISP increases above 15-20 mmHg and that there is delayed cord swelling after injury, which implies that adequate cord decompression confirmed during surgery by ultrasound may not persist postoperatively.
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Affiliation(s)
- Hasan Asif
- Academic Neurosurgery Unit, Neuroscience and Cell Biology Research Institute, St. George’s, University of London, London, UK
| | - Ravindran Visagan
- Academic Neurosurgery Unit, Neuroscience and Cell Biology Research Institute, St. George’s, University of London, London, UK
| | - Ellaine Boseta
- Academic Neurosurgery Unit, Neuroscience and Cell Biology Research Institute, St. George’s, University of London, London, UK
- Neuro-Intensive Care, St. George’s Hospital NHS Foundation Trust, London, UK
| | - Argyro Zoumprouli
- Neuro-Intensive Care, St. George’s Hospital NHS Foundation Trust, London, UK
- Neuro-Anaesthesia, St. George’s Hospital NHS Foundation Trust, London, UK
| | - Marios C. Papadopoulos
- Academic Neurosurgery Unit, Neuroscience and Cell Biology Research Institute, St. George’s, University of London, London, UK
| | - Samira Saadoun
- Academic Neurosurgery Unit, Neuroscience and Cell Biology Research Institute, St. George’s, University of London, London, UK
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Seblani M, Ertlen C, Coyle T, Decherchi P, Brezun JM. Combined effect of trifluoperazine and sodium cromoglycate on reducing acute edema and limiting lasting functional impairments after spinal cord injury in rats. Exp Neurol 2024; 372:114612. [PMID: 37993080 DOI: 10.1016/j.expneurol.2023.114612] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 11/10/2023] [Accepted: 11/15/2023] [Indexed: 11/24/2023]
Abstract
Edema formation is one of the very first events to occur after spinal cord injury (SCI) leading to an increase of the intrathecal pressure and consequently to serious spinal tissue and functional impairments. Current edema treatments are still symptomatic and/or non-specific. Since edema formation mechanisms are mainly described as vasogenic and cytotoxic, it becomes crucial to understand the interplay between these two subtypes. Acting on key targets to inhibit edema formation may reduce secondary damage and related functional impairments. In this study, we characterize the edema kinetic after T9-10 spinal contusion. We use trifluoperazine (TFP) to block the expression and the functional subcellular localization of aquaporin-4 supposed to be implicated in the cytotoxic edema formation. We also use sodium cromoglycate (SCG) to deactivate mast cell degranulation known to be implicated in the vasogenic edema formation. Our results show a significant reduction of edema after TFP treatment and after TFP-SCG combined treatment compared to control. This reduction is correlated with limited onset of initial sensorimotor impairments particularly after combined treatment. Our results highlight the importance of potential synergetic targets in early edema therapy after SCI as part of tissue sparing strategies.
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Affiliation(s)
- Mostafa Seblani
- Aix Marseille Univ, CNRS, ISM, UMR7287, Institut des Sciences du Mouvement: Etienne-Jules MAREY, Team "Plasticité des Systèmes Nerveux et Musculaire" (PSNM), Parc Scientifique et Technologique de Luminy, CC910-163, Avenue de Luminy, F-13288 Marseille, Cedex 09, France
| | - Céline Ertlen
- Aix Marseille Univ, CNRS, ISM, UMR7287, Institut des Sciences du Mouvement: Etienne-Jules MAREY, Team "Plasticité des Systèmes Nerveux et Musculaire" (PSNM), Parc Scientifique et Technologique de Luminy, CC910-163, Avenue de Luminy, F-13288 Marseille, Cedex 09, France
| | - Thelma Coyle
- Aix Marseille Univ, CNRS, ISM, UMR7287, Institut des Sciences du Mouvement: Etienne-Jules MAREY, Team "Plasticité des Systèmes Nerveux et Musculaire" (PSNM), Parc Scientifique et Technologique de Luminy, CC910-163, Avenue de Luminy, F-13288 Marseille, Cedex 09, France
| | - Patrick Decherchi
- Aix Marseille Univ, CNRS, ISM, UMR7287, Institut des Sciences du Mouvement: Etienne-Jules MAREY, Team "Plasticité des Systèmes Nerveux et Musculaire" (PSNM), Parc Scientifique et Technologique de Luminy, CC910-163, Avenue de Luminy, F-13288 Marseille, Cedex 09, France
| | - Jean-Michel Brezun
- Aix Marseille Univ, CNRS, ISM, UMR7287, Institut des Sciences du Mouvement: Etienne-Jules MAREY, Team "Plasticité des Systèmes Nerveux et Musculaire" (PSNM), Parc Scientifique et Technologique de Luminy, CC910-163, Avenue de Luminy, F-13288 Marseille, Cedex 09, France.
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4
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Adegeest CY, Ter Wengel PV, Peul WC. Traumatic spinal cord injury: acute phase treatment in critical care. Curr Opin Crit Care 2023; 29:659-665. [PMID: 37909371 DOI: 10.1097/mcc.0000000000001110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
PURPOSE OF REVIEW Surgical timing in traumatic spinal cord injury (t-SCI) remains a point of debate. Current guidelines recommend surgery within 24 h after trauma; however, earlier timeframes are currently intensively being investigated. The aim of this review is to provide an insight on the acute care of patients with t-SCI. RECENT FINDINGS Multiple studies show that there appears to be a beneficial effect on neurological recovery of early surgical decompression within 24 h after trauma. Currently, the impact of ultra-early surgery is less clear as well as lacking evidence for the most optimal surgical technique. Nevertheless, early surgery to decompress the spinal cord by whatever method can impact the occurrence for perioperative complications and potentially expedite rehabilitation. There are clinical and socioeconomic barriers in achieving timely and adequate surgical interventions for t-SCI. SUMMARY In this review, we provide an overview of the recent insights of surgical timing in t-SCI and the current barriers in acute t-SCI treatment.
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Affiliation(s)
- Charlotte Y Adegeest
- University Neurosurgical Center Holland (UNCH), LUMC | HMC | HAGA, Leiden-The Hague, the Netherlands
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5
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Santifort KM, Carrera I, Platt S. Case report: Traumatic hemorrhagic cervical myelopathy in a dog. Front Vet Sci 2023; 10:1260719. [PMID: 37869493 PMCID: PMC10585029 DOI: 10.3389/fvets.2023.1260719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/21/2023] [Indexed: 10/24/2023] Open
Abstract
A 1.5-year-old female entire French bulldog was referred for neurological evaluation, further diagnostic tests, and treatment 24 h after a road traffic accident. Initial emergency treatment, diagnostic tests, and stabilization had been performed by the referring veterinarian. Neurological examination revealed severe spastic non-ambulatory tetraparesis and was consistent with a C1-5 myelopathy. A magnetic resonance imaging (MRI) study revealed an irregular to elongated ovoid intramedullary lesion centered over the body of C2. The lesion showed marked signal heterogeneity with a central T2W and T2* hyperintense region, surrounded by a hypointense rim on both sequences. The lesion appeared heterogeneously T1W hypointense. The lesion was asymmetric (right-sided), affecting both white and gray matter. The C2-3 intervertebral disk appeared moderately degenerate with a Pfirrmann grade of 3. No evidence of vertebral fracture or luxation was found on radiographs or MRI of the vertebral column. Additional soft tissue abnormalities in the area of the right brachial plexus were suggestive of brachial plexus and muscle injury. A diagnosis of traumatic hemorrhagic myelopathy at the level of C2 and concurrent brachial plexus injury was formed. Conservative treatment was elected and consisted of physiotherapy, bladder care with an indwelling urinary catheter, repeated IV methadone based on pain scoring (0.2 mg/kg), oral meloxicam 0.1 mg/kg q24h, and oral gabapentin 10 mg/kg q8h. The dog was discharged after 4 days, with an indwelling urinary catheter and oral medication as described. The catheter was replaced two times by the referring veterinarian and finally removed after 10 days. Thereafter, voluntary urination was seen. During the 2 months after the road traffic accident, slow recovery of motor function was seen. The right thoracic limb recovery progressed more slowly than the left limb, also showing some lower motor neuron signs during follow-up. This was judged to be consistent with a right-sided brachial plexus injury. The dog was reported ambulatory with mild residual ataxia and residual monoparesis of the right thoracic limb at the last follow-up 3 months post-injury. This case report highlights the MRI-based diagnosis of traumatic hemorrhagic myelopathy in a dog. A fair short-term outcome was achieved with conservative treatment in this case.
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Affiliation(s)
- Koen M. Santifort
- IVC Evidensia Small Animal Referral Hospital Arnhem, Neurology, Arnhem, Netherlands
- IVC Evidensia Small Animal Referral Hospital Hart van Brabant, Neurology, Waalwijk, Netherlands
| | - Ines Carrera
- Vet Oracle Teleradiology, Norfolk, United Kingdom
| | - Simon Platt
- Vet Oracle Teleradiology, Norfolk, United Kingdom
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6
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Garcia TA, Jonak CR, Binder DK. The Role of Aquaporins in Spinal Cord Injury. Cells 2023; 12:1701. [PMID: 37443735 PMCID: PMC10340765 DOI: 10.3390/cells12131701] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/08/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
Edema formation following traumatic spinal cord injury (SCI) exacerbates secondary injury, and the severity of edema correlates with worse neurological outcome in human patients. To date, there are no effective treatments to directly resolve edema within the spinal cord. The aquaporin-4 (AQP4) water channel is found on plasma membranes of astrocytic endfeet in direct contact with blood vessels, the glia limitans in contact with the cerebrospinal fluid, and ependyma around the central canal. Local expression at these tissue-fluid interfaces allows AQP4 channels to play an important role in the bidirectional regulation of water homeostasis under normal conditions and following trauma. In this review, we consider the available evidence regarding the potential role of AQP4 in edema after SCI. Although more work remains to be carried out, the overall evidence indicates a critical role for AQP4 channels in edema formation and resolution following SCI and the therapeutic potential of AQP4 modulation in edema resolution and functional recovery. Further work to elucidate the expression and subcellular localization of AQP4 during specific phases after SCI will inform the therapeutic modulation of AQP4 for the optimization of histological and neurological outcomes.
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Affiliation(s)
- Terese A. Garcia
- Division of Biomedical Sciences, School of Medicine, University of California, Riverside, CA 92521, USA
| | - Carrie R. Jonak
- Division of Biomedical Sciences, School of Medicine, University of California, Riverside, CA 92521, USA
| | - Devin K. Binder
- Division of Biomedical Sciences, School of Medicine, University of California, Riverside, CA 92521, USA
- Center for Glial-Neuronal Interactions, University of California, Riverside, CA 92521, USA
- Neuroscience Graduate Program, University of California, Riverside, CA 92521, USA
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7
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Seblani M, Decherchi P, Brezun JM. Edema after CNS Trauma: A Focus on Spinal Cord Injury. Int J Mol Sci 2023; 24:ijms24087159. [PMID: 37108324 PMCID: PMC10138956 DOI: 10.3390/ijms24087159] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/09/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
Edema after spinal cord injury (SCI) is one of the first observations after the primary injury and lasts for few days after trauma. It has serious consequences on the affected tissue and can aggravate the initial devastating condition. To date, the mechanisms of the water content increase after SCI are not fully understood. Edema formation results in a combination of interdependent factors related to mechanical damage after the initial trauma progressing, along with the subacute and acute phases of the secondary lesion. These factors include mechanical disruption and subsequent inflammatory permeabilization of the blood spinal cord barrier, increase in the capillary permeability, deregulation in the hydrostatic pressure, electrolyte-imbalanced membranes and water uptake in the cells. Previous research has attempted to characterize edema formation by focusing mainly on brain swelling. The purpose of this review is to summarize the current understanding of the differences in edema formation in the spinal cord and brain, and to highlight the importance of elucidating the specific mechanisms of edema formation after SCI. Additionally, it outlines findings on the spatiotemporal evolution of edema after spinal cord lesion and provides a general overview of prospective treatment strategies by focusing on insights to prevent edema formation after SCI.
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Affiliation(s)
- Mostafa Seblani
- Aix Marseille Univ, CNRS, ISM, UMR 7287, Institut des Sciences du Mouvement: Etienne-Jules MAREY, Equipe «Plasticité des Systèmes Nerveux et Musculaire» (PSNM), Parc Scientifique et Technologique de Luminy, CC910-163, Avenue de Luminy, F-13288 Marseille, CEDEX 09, France
| | - Patrick Decherchi
- Aix Marseille Univ, CNRS, ISM, UMR 7287, Institut des Sciences du Mouvement: Etienne-Jules MAREY, Equipe «Plasticité des Systèmes Nerveux et Musculaire» (PSNM), Parc Scientifique et Technologique de Luminy, CC910-163, Avenue de Luminy, F-13288 Marseille, CEDEX 09, France
| | - Jean-Michel Brezun
- Aix Marseille Univ, CNRS, ISM, UMR 7287, Institut des Sciences du Mouvement: Etienne-Jules MAREY, Equipe «Plasticité des Systèmes Nerveux et Musculaire» (PSNM), Parc Scientifique et Technologique de Luminy, CC910-163, Avenue de Luminy, F-13288 Marseille, CEDEX 09, France
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8
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Mora-Boga R, Vázquez Muíños O, Pértega Díaz S, Meijide-Faílde RM, Rodríguez-Sotillo A, Ferreiro-Velasco ME, Salvador-de la Barrera S, Montoto-Marqués A. Prognostic value of early magnetic resonance imaging in the morbidity and mortality of traumatic spinal cord injury. Med Intensiva 2023; 47:157-164. [PMID: 36068148 DOI: 10.1016/j.medine.2022.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/19/2021] [Accepted: 01/07/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To assess in individuals with traumatic spinal cord injury (TSCI) the relationship between mortality and need for ICU and early magnetic resonance imaging (MRI), analyzing spinal parenchymal alterations, disruption of vertebral ligaments (DVL) and spinal cord compression (SCC). DESIGN Retrospective study. SETTING Third-level hospital, Spinal Cord Injury Unit and ICU. PATIENTS Individuals with acute TSCI between 2010 and 2019. INTERVENTION Analysis of MRI performed in the first 72 h. VARIABLES OF INTEREST Admission to ICU and mortality. RESULTS 269 cases collected. The pattern that demonstrated higher mortality was cord hemorrhage (16.7%) for 12.5% of single-level edema and 6.5% of multilevel edema (p = 0.125). The same happened with ICU admissions: 69.0% in hemorrhage, 60.2% in multilevel edema and 46.3% in short edema (p = 0.018). Analyzing CCM, mortality was 13.4% with 59.2% of ICU admissions, for 2.2% and 42.2% of individuals without cord compression (p = 0.020 and p = 0.003). The figures of death and ICU admission among cord injuries with DVL were 15.0% and 67.3%, for 6.2% and 44.4% of the individuals without DLV (p < 0.001 and p = 0.013). CONCLUSIONS The presence of spinal cord hemorrhage, SCC and DVL was associated with a higher admission in ICU. A significant increase in mortality was observed in cases with SCC and DVL.
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Affiliation(s)
- Rubén Mora-Boga
- Unidad de Lesionados Medulares, Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain.
| | - Olalla Vázquez Muíños
- Unidad de Neurorradiología, Servicio de Radiodiagnóstico, Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Sonia Pértega Díaz
- Unidad de Estadística y Epidemiología Clínica, Spanish Clinical Research Network (SCReN). Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Rosa María Meijide-Faílde
- Departamento de Fisioterapia, Medicina y Ciencias Biomédicas, Universidade de A Coruña (UDC), A Coruña, Spain
| | - Antonio Rodríguez-Sotillo
- Unidad de Lesionados Medulares, Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain; Departamento de Fisioterapia, Medicina y Ciencias Biomédicas, Universidade de A Coruña (UDC), A Coruña, Spain
| | | | | | - Antonio Montoto-Marqués
- Unidad de Lesionados Medulares, Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain; Departamento de Fisioterapia, Medicina y Ciencias Biomédicas, Universidade de A Coruña (UDC), A Coruña, Spain
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Ridia KGM, Astawa P, Deslivia MF, Santosa C, Savio SD. A Systematic Review of Scoring System Based on Magnetic Resonance Imaging Parameters to Predict Outcome in Cervical Spinal Cord Injury. Spine Surg Relat Res 2023; 7:1-12. [PMID: 36819628 PMCID: PMC9931401 DOI: 10.22603/ssrr.2021-0255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 06/06/2022] [Indexed: 11/05/2022] Open
Abstract
Background Magnetic resonance imaging (MRI) is a potential tool for the objective assessment of spinal cord injury (SCI) because it correlates well with the spatial and temporal extension of spinal cord pathology. This study aimed to systematically identify currently available scoring system based on MRI parameters, including measurement of the spinal cord lesion length in sagittal view (intramedullary lesion length (IMLL)) and morphology of the lesion in axial view (Brain and Spinal Injury Center (BASIC) score). Methods A systematic search was conducted using the PubMed/MEDLINE database for English-language studies with the keywords "cervical," "spinal cord injury," "scoring system," "scoring," "classification," and "magnetic resonance imaging" to systematically identify the scoring system based on MRI parameters. The main outcomes of interest are the scoring system's inter- and intraobserver reliabilities and its predictive accuracy of neurological outcome. Results After assessing the full text and applying the inclusion and exclusion criteria, 13 articles were found to be eligible. The inter- and intraobserver reliabilities were rated as good until perfect for increased signal intensity (ISI), maximum canal compromise (MCC), maximum spinal cord compression (MSCC), BASIC score, cord-canal-area ratio, space available for the cord, and the compression ratio. The weighted mean difference of IML between the group with converted ASIA Impairment Scale (AIS) grade and the group without conversion is 31.79 (I2 =93%, P=0.008). The percentage of agreement between the initial BASIC score of 4 with AIS grade of A at follow-up is 100%. Conclusions Certain MRI parameters, including IML and BASIC score, have good reliability and correlate well with neurological outcome, making them candidates for building simple and objective scoring system for cervical SCI. Level of Evidence: 2A.
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Affiliation(s)
- K G Mulyadi Ridia
- Consultant of Orthopaedics and Traumatology Department, Faculty of Medicine Udayana University, Sanglah General Hospital, Denpasar, Bali, Indonesia
| | - Putu Astawa
- Consultant of Orthopaedics and Traumatology Department, Faculty of Medicine Udayana University, Sanglah General Hospital, Denpasar, Bali, Indonesia
| | - Maria Florencia Deslivia
- Resident of Orthopaedics and Traumatology Department, Faculty of Medicine Udayana University, Sanglah General Hospital, Denpasar, Bali, Indonesia
| | - Claudia Santosa
- Resident of Orthopaedics and Traumatology Department, Faculty of Medicine Udayana University, Sanglah General Hospital, Denpasar, Bali, Indonesia
| | - Sherly Desnita Savio
- Resident of Orthopaedics and Traumatology Department, Faculty of Medicine Udayana University, Sanglah General Hospital, Denpasar, Bali, Indonesia
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10
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Bessen MA, Gayen CD, Quarrington RD, Walls AC, Leonard AV, Kurtcuoglu V, Jones CF. Characterising spinal cerebrospinal fluid flow in the pig with phase-contrast magnetic resonance imaging. Fluids Barriers CNS 2023; 20:5. [PMID: 36653870 PMCID: PMC9850564 DOI: 10.1186/s12987-022-00401-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/13/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Detecting changes in pulsatile cerebrospinal fluid (CSF) flow may assist clinical management decisions, but spinal CSF flow is relatively understudied. Traumatic spinal cord injuries (SCI) often cause spinal cord swelling and subarachnoid space (SAS) obstruction, potentially causing pulsatile CSF flow changes. Pigs are emerging as a favoured large animal SCI model; therefore, the aim of this study was to characterise CSF flow along the healthy pig spine. METHODS Phase-contrast magnetic resonance images (PC-MRI), retrospectively cardiac gated, were acquired for fourteen laterally recumbent, anaesthetised and ventilated, female domestic pigs (22-29 kg). Axial images were obtained at C2/C3, T8/T9, T11/T12 and L1/L2. Dorsal and ventral SAS regions of interest (ROI) were manually segmented. CSF flow and velocity were determined throughout a cardiac cycle. Linear mixed-effects models, with post-hoc comparisons, were used to identify differences in peak systolic/diastolic flow, and maximum velocity (cranial/caudal), across spinal levels and dorsal/ventral SAS. Velocity wave speed from C2/C3 to L1/L2 was calculated. RESULTS PC-MRI data were obtained for 11/14 animals. Pulsatile CSF flow was observed at all spinal levels. Peak systolic flow was greater at C2/C3 (dorsal: - 0.32 ± 0.14 mL/s, ventral: - 0.15 ± 0.13 mL/s) than T8/T9 dorsally (- 0.04 ± 0.03 mL/s; p < 0.001), but not different ventrally (- 0.08 ± 0.08 mL/s; p = 0.275), and no difference between thoracolumbar levels (p > 0.05). Peak diastolic flow was greater at C2/C3 (0.29 ± 0.08 mL/s) compared to T8/T9 (0.03 ± 0.03 mL/s, p < 0.001) dorsally, but not different ventrally (p = 1.000). Cranial and caudal maximum velocity at C2/C3 were greater than thoracolumbar levels dorsally (p < 0.001), and T8/T9 and L1/L2 ventrally (p = 0.022). Diastolic velocity wave speed was 1.41 ± 0.39 m/s dorsally and 1.22 ± 0.21 m/s ventrally, and systolic velocity wave speed was 1.02 ± 0.25 m/s dorsally and 0.91 ± 0.22 m/s ventrally. CONCLUSIONS In anaesthetised and ventilated domestic pigs, spinal CSF has lower pulsatile flow and slower velocity wave propagation, compared to humans. This study provides baseline CSF flow at spinal levels relevant for future SCI research in this animal model.
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Affiliation(s)
- Madeleine Amy Bessen
- grid.1010.00000 0004 1936 7304Adelaide Spinal Research Group and Centre for Orthopaedics and Trauma Research, Adelaide Medical School, The University of Adelaide, Level 7, Adelaide Health and Medical Sciences Building, The University of Adelaide, North Terrace, Adelaide, SA 5005 Australia
| | - Christine Diana Gayen
- grid.1010.00000 0004 1936 7304Adelaide Spinal Research Group and Centre for Orthopaedics and Trauma Research, Adelaide Medical School, The University of Adelaide, Level 7, Adelaide Health and Medical Sciences Building, The University of Adelaide, North Terrace, Adelaide, SA 5005 Australia ,grid.1010.00000 0004 1936 7304Translational Neuropathology Laboratory, School of Biomedicine, The University of Adelaide, Level 2, Helen Mayo North Building, The University of Adelaide, Frome Road, Adelaide, SA 5005 Australia
| | - Ryan David Quarrington
- grid.1010.00000 0004 1936 7304Adelaide Spinal Research Group and Centre for Orthopaedics and Trauma Research, Adelaide Medical School, The University of Adelaide, Level 7, Adelaide Health and Medical Sciences Building, The University of Adelaide, North Terrace, Adelaide, SA 5005 Australia ,grid.1010.00000 0004 1936 7304School of Electrical and Mechanical Engineering, The University of Adelaide, North Terrace, Adelaide, SA 5005 Australia
| | - Angela Catherine Walls
- grid.430453.50000 0004 0565 2606Clinical and Research Imaging Centre, South Australian Health and Medical Research Institute, National Imaging Facility, Northern Pod, SAHMRI, North Terrace, Adelaide, SA 5000 Australia
| | - Anna Victoria Leonard
- grid.1010.00000 0004 1936 7304Translational Neuropathology Laboratory, School of Biomedicine, The University of Adelaide, Level 2, Helen Mayo North Building, The University of Adelaide, Frome Road, Adelaide, SA 5005 Australia
| | - Vartan Kurtcuoglu
- grid.7400.30000 0004 1937 0650Institute of Physiology, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland ,grid.7400.30000 0004 1937 0650Zurich Center for Integrative Human Physiology, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland ,grid.7400.30000 0004 1937 0650Neuroscience Center Zurich, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Claire Frances Jones
- grid.1010.00000 0004 1936 7304Adelaide Spinal Research Group and Centre for Orthopaedics and Trauma Research, Adelaide Medical School, The University of Adelaide, Level 7, Adelaide Health and Medical Sciences Building, The University of Adelaide, North Terrace, Adelaide, SA 5005 Australia ,grid.1010.00000 0004 1936 7304School of Electrical and Mechanical Engineering, The University of Adelaide, North Terrace, Adelaide, SA 5005 Australia ,grid.416075.10000 0004 0367 1221Department of Orthopaedics, Royal Adelaide Hospital, Adelaide, SA 5000 Australia
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11
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Lee SY, Schmit BD, Kurpad SN, Budde MD. Acute Magnetic Resonance Imaging Predictors of Chronic Motor Function and Tissue Sparing in Rat Cervical Spinal Cord Injury. J Neurotrauma 2022; 39:1727-1740. [PMID: 35708112 PMCID: PMC9734017 DOI: 10.1089/neu.2022.0034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Predicting functional outcomes from spinal cord injury (SCI) at the acute setting is important for patient management. This work investigated the relationship of early magnetic resonance imaging (MRI) biomarkers in a rat model of cervical contusion SCI with long-term functional outcome and tissue sparing. Forty rats with contusion injury at C5 at either the spinal cord midline (bilateral) or over the lateral cord (unilateral) were examined using in vivo multi-modal quantitative MRI at 1 day post-injury. The extent of T2-weighted hyperintensity reflecting edema was greater in the bilateral model compared with the unilateral injury. Diffusion tensor imaging (DTI) exhibited microscopic damage in similar regions of the cord as reductions in fractional anisotropy (FA) and mean diffusivity (MD), but DTI parameter maps were also confounded by the presence of vasogenic edema that locally increased FA and MD. In comparison, filtered diffusion-weighted imaging (fDWI) more clearly delineated the location of acute axonal damage without effects of vasogenic edema. Pairwise correlation analysis revealed that 28-day motor functional outcomes were most strongly associated with the extent of edema (R = -0.69). Principal component analysis identified close associations of motor functional score with tissue sparing, the extent of edema, lesion area, and injury type (unilateral or bilateral). Among the diffusion MRI parameters, lesion areas measured with fDWI had the strongest association with functional outcome (R = -0.41). Voxelwise correlation analysis identified a locus of white matter damage associated with function in the dorsal white matter, although this was likely driven by variance across the two injury patterns (unilateral and bilateral injury). Nonetheless, correlation with motor function within the damaged region found in the voxelwise analysis outperformed morphological lesion area measurement as a predictor of chronic function. Collectively, this study characterized anatomical and diffusion MRI signatures of acute SCI at cervical spine and their association with chronic functional outcomes and histological results.
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Affiliation(s)
- Seung-Yi Lee
- Neuroscience Doctoral Program, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Biophysics Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Brian D. Schmit
- Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Shekar N. Kurpad
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Matthew D. Budde
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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12
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Malomo T, Allard Brown A, Bale K, Yung A, Kozlowski P, Heran M, Streijger F, Kwon BK. Quantifying Intraparenchymal Hemorrhage after Traumatic Spinal Cord Injury: A Review of Methodology. J Neurotrauma 2022; 39:1603-1635. [PMID: 35538847 DOI: 10.1089/neu.2021.0317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Intraparenchymal hemorrhage (IPH) after a traumatic injury has been associated with poor neurological outcomes. Although IPH may result from the initial mechanical trauma, the blood and its breakdown products have potentially deleterious effects. Further, the degree of IPH has been correlated with injury severity and the extent of subsequent recovery. Therefore, accurate evaluation and quantification of IPH following traumatic spinal cord injury (SCI) is important to define treatments' effects on IPH progression and secondary neuronal injury. Imaging modalities, such as magnetic resonance imaging (MRI) and ultrasound (US), have been explored by researchers for the detection and quantification of IPH following SCI. Both quantitative and semiquantitative MRI and US measurements have been applied to objectively assess IPH following SCI, but the optimal methods for doing so are not well established. Studies in animal SCI models (rodent and porcine) have explored US and histological techniques in evaluating SCI and have demonstrated the potential to detect and quantify IPH. Newer techniques using machine learning algorithms (such as convolutional neural networks [CNN]) have also been studied to calculate IPH volume and have yielded promising results. Despite long-standing recognition of the potential pathological significance of IPH within the spinal cord, quantifying IPH with MRI or US is a relatively new area of research. Further studies are warranted to investigate their potential use. Here, we review the different and emerging quantitative MRI, US, and histological approaches used to detect and quantify IPH following SCI.
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Affiliation(s)
- Toluyemi Malomo
- International Collaboration on Repair Discoveries, Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Aysha Allard Brown
- International Collaboration on Repair Discoveries, Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kirsten Bale
- International Collaboration on Repair Discoveries, Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.,UBC MRI Research Center, Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew Yung
- International Collaboration on Repair Discoveries, Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.,UBC MRI Research Center, Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Piotr Kozlowski
- International Collaboration on Repair Discoveries, Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.,UBC MRI Research Center, Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Manraj Heran
- Department of Radiology, Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Femke Streijger
- International Collaboration on Repair Discoveries, Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian K Kwon
- International Collaboration on Repair Discoveries, Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver Spine Surgery Institute, Department of Orthopaedics, and Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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13
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Superiority of Brain and Spinal Injury Center Score for Assessing Injury Severity and Predicting Prognosis in Patients with Acute Traumatic Spinal Cord Injury. Clin Neuroradiol 2022; 32:1117-1125. [PMID: 35394137 DOI: 10.1007/s00062-022-01154-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 03/03/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE The goal of this study was to evaluate the interrelationship between different magnetic resonance (MR) imaging measures and their validity in assessing the severity of acute traumatic spinal cord injury (tSCI) and predicting neurological outcomes. METHODS We performed a preoperative multicenter cohort study of 89 patients with acute tSCI and preoperative MR imaging within 24 h after injury. We assessed several MR imaging measures of injury, including axial grade (Brain and Spinal Injury Center [BASIC] score), sagittal grade, length of injury, maximum canal compromise (MCC), and maximum spinal cord compression (MSCC). Principal component analysis (PCA) was applied to evaluate the interrelationship between different MR imaging measures. Spearman correlation and regression analyses were applied to assess injury severity and predict neurological impairment. The severity was assessed by the American Spinal Injury Association Impairment Scale (AIS) at admission, while neurological outcome was defined by AIS grade change at 6 weeks, AIS grade and SCIM score at 1 year after surgery. RESULTS The PCA identified 2 clusters of MR imaging variables related to 1) measures of intrinsic cord signal abnormality (BASIC score, sagittal grade and length of injury) and 2) measures of extrinsic cord compression (MCC and MSCC). Neurological outcome and injury severity were best accounted for by MR imaging measures of intrinsic cord signal abnormalities, with the BASIC score representing the most accurate predictor of short-term and long-term neurological outcomes. CONCLUSION We determined the superior significance of the BASIC score in assessing injury severity, predicting early AIS improvement, AIS grade and SCIM score at 1 year compared with other MR imaging measures.
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14
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Gayen CD, Bessen MA, Dorrian RM, Quarrington RD, Mulaibrahimovic A, Doig RLO, Freeman BJC, Leonard AV, Jones CF. A survival model of thoracic contusion spinal cord injury in the domestic pig. J Neurotrauma 2022; 40:965-980. [PMID: 36200622 DOI: 10.1089/neu.2022.0281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Spinal cord injury (SCI) frequently results in motor, sensory and autonomic dysfunction for which there is currently no cure. Recent preclinical and clinical research has led to promising advances in treatment; however, therapeutics indicating promise in rodents have not translated successfully in human trials, likely due, in part, to gross anatomical and physiological differences between the species. Therefore, large animal models of SCI may facilitate the study of secondary injury processes that are influenced by scale, and assist the translation of potential therapeutic interventions. The aim of this study was to characterize two severities of thoracic contusion SCI in female domestic pigs, measuring motor function and spinal cord lesion characteristics, over two weeks post-SCI. A custom instrumented weight drop injury device was used to release a 50 g impactor from 10 cm (n=3) or 20 cm (n=7) onto the exposed dura, to induce a contusion at the T10 thoracic spinal level. Hind limb motor function was assessed at 8 and 13 days post-SCI using a 10-point scale. Volume and extent of lesion-associated signal hyperintensity in T2-weighted magnetic resonance (MR) images was assessed at 3, 7 and 14 days post-injury. Animals were transcardially perfused at 14 days post-SCI and spinal cord tissue was harvested for histological analysis. Bowel function was retained in all animals and transient urinary retention occurred in two animals after catheter removal. All animals displayed hind limb motor deficits. Animals in the 10 cm group demonstrated some stepping and weight bearing and scored a median 2-3 points higher on the 10-point motor function scale at 8 and 13 days post-SCI, than the 20 cm group. Histological lesion volume was 20 % greater, and 30 % less white matter was spared, in the 20 cm group than in the 10 cm group. The MR signal hyperintensity in the 20 cm injury group had a median cranial-caudal extent approximately 1.5 times greater than the 10 cm injury group at all three time points, and median volumes 1.8, 2.5 and 4.5 times greater at day 3, 7 and 14 post-injury, respectively. Regional differences in axonal injury were observed between groups, with amyloid precursor protein immunoreactivity greatest in the 20 cm group in spinal cord sections adjacent the injury epicenter. This study demonstrated graded injuries in a domestic pig strain, with outcome measures comparable to miniature pig models of contusion SCI. The model provides a vehicle for the study of SCI and potential treatments, particularly where miniature pig strains are not available and/or where small animal models are not appropriate for the research question.
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Affiliation(s)
- Christine D Gayen
- Translational Neuropathology Laboratory, School of Biomedicine, The University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Spinal Research Group, Centre for Orthopaedics and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Madeleine A Bessen
- Adelaide Spinal Research Group, Centre for Orthopaedics and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Ryan M Dorrian
- Translational Neuropathology Laboratory, School of Biomedicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Ryan D Quarrington
- Adelaide Spinal Research Group, Centre for Orthopaedics and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Adnan Mulaibrahimovic
- Adelaide Spinal Research Group, Centre for Orthopaedics and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Ryan L O'Hare Doig
- Neil Sachse Centre for Spinal Cord Research, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Brian J C Freeman
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide South Australia, Australia
| | - Anna V Leonard
- Translational Neuropathology Laboratory, School of Biomedicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Claire F Jones
- Adelaide Spinal Research Group, Centre for Orthopaedics and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- School of Mechanical Engineering, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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15
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Franz S, Eck U, Schuld C, Heutehaus L, Wolf M, Wilder-Smith E, Schulte-Mattler W, Weber MA, Rupp R, Weidner N. Lower motoneuron dysfunction impacts spontaneous motor recovery in acute cervical spinal cord injury. J Neurotrauma 2022; 40:862-875. [PMID: 36006372 PMCID: PMC10162119 DOI: 10.1089/neu.2022.0181] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Paresis after spinal cord injury is caused by damage to upper and lower motoneurons and may differentially impact neurological recovery. This prospective monocentric longitudinal observational study investigated the extent and severity of lower motoneuron dysfunction and its impact on upper extremity motor recovery after acute cervical spinal cord injury. Pathological spontaneous activity at rest and/or increased discharge rates of motor unit action potentials recorded by needle electromyography (EMG) were taken as parameters for lower motoneuron dysfunction and its relation to the extent of myelopathy in the first available spine MRI was determined. Motor recovery was assessed by standardized neurological examination within the first 4 weeks (acute stage) and up to 1 year (chronic stage) after injury. Eighty-five muscles of 17 individuals with cervical spinal cord injury (neurological level of injury from C1 to C7) and a median age of 54 (28-59) were examined. The results showed that muscles with signs of lower motoneuron dysfunction peaked at the lesion center (Χ²[2,n=85]=6.6, p=0.04) and that the severity of lower motoneuron dysfunction correlated with T2-weighted hyperintense MRI signal changes in routine spine MRI at the lesion site (spearman ρ=0.31, p=0.01). Muscles exhibiting signs of lower motoneuron dysfunction, as indicated by pathological spontaneous activity at rest and/or increased discharge rates of motor unit action potentials, were associated with more severe paresis in both the acute and chronic stages after spinal cord injury (spearman ρ acute=-0.22, p=0.04 and chronic=-0.31, p=0.004). Moreover, the severity of lower motoneuron dysfunction in the acute stage was also associated with a greater degree of paresis (spearman ρ acute=-0.24, p=0.03 and chronic=-0.35, p=0.001). While both muscles with and without signs of lower motoneuron dysfunction were capable of regaining strength over time, those without lower motoneuron dysfunctions had a higher potential to reach full strength. Muscles with signs of lower motoneuron dysfunction in the acute stage displayed increased amplitudes of motor unit action potentials with chronic-stage needle EMG, indicating reinnervation through peripheral collateral sprouting as compensatory mechanism (Χ²[1,n=72]=4.3, p=0.04). Thus, lower motoneuron dysfunction represents a relevant factor contributing to motor impairment and recovery in acute cervical spinal cord injury. Defined recovery mechanisms (peripheral reinnervation) may at least partially underlie spontaneous recovery in respective muscles. Therefore, assessment of lower motoneuron dysfunction could help refine prediction of motor recovery following spinal cord injury.
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Affiliation(s)
- Steffen Franz
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
- Address correspondence to: Steffen Franz, MD, Spinal Cord Injury Center, Heidelberg University Hospital, Schlierbacher Landstraße 200 a, 69118 Heidelberg, Germany
| | - Ute Eck
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Schuld
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Laura Heutehaus
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Marcel Wolf
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Einar Wilder-Smith
- Department of Neurology, Kantonsspital Lucerne, Lucerne, Switzerland
- Department of Neurology, Inselspital Bern, University of Bern, Bern, Switzerland
| | | | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Rüdiger Rupp
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Norbert Weidner
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
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16
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Imaging of Thoracolumbar Spine Traumas. Eur J Radiol 2022; 154:110343. [DOI: 10.1016/j.ejrad.2022.110343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 11/15/2022]
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17
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Neurological recovery after traumatic spinal cord injury: prognostic value of magnetic resonance. Spinal Cord 2022; 60:533-539. [PMID: 35105961 DOI: 10.1038/s41393-022-00759-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 01/18/2022] [Accepted: 01/23/2022] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Retrospective observational study. OBJECTIVES Assess the relationship between Magnetic Resonance (MR) image patterns and neurological recovery in patients with Traumatic Spinal Cord Injury (TSCI). SETTING Spinal cord injury unit in Spain. METHODS Patients admitted for acute TSCI between January 2010 and December 2018 with a MR exam performed in the acute phase were selected. Five patterns were established: normal, single-level edema, multilevel edema, hemorrhage, and spinal cord transection. Comparisons between the ASIA Injury Severity (AIS) score and Motor Index (MI) at admission and at discharge were made. RESULTS Collected 296 patients. Normal and cord transection patterns were excluded due to the low number of cases. Single-level edema pattern was primarily observed in cases with incomplete injuries, hemorrhage pattern in complete injuries, and multilevel edema pattern at similar percentages in complete and incomplete lesions. Improvement of the AIS score was found in 40.9% of single-level edema, 20.2% of multilevel edema, and 19.0% of hemorrhage (p = 0.042) patterns. By excluding the AIS grade D from the analyses, the figures increased to 70.3%, 52.2%, and 19.4% respectively (p < 0.001). This significant relationship was confirmed by multivariate analysis, although it was not as relevant as the examination according to ASIA-ISCoS performed at admission (p = 0.005 vs p < 0.001). Mean variation of the MI was also significantly different (p < 0.001) between the three groups: 22.6 ± 21.4 for single-level edema, 16.9 ± 21.1 for multilevel edema, and 4.5 ± 8.4 for hemorrhage. CONCLUSION MR injury patterns observed at the acute phase are associated with the possibility of improvement of the AIS score and MI.
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18
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Mora-Boga R, Vázquez Muíños O, Pértega Díaz S, Meijide-Faílde R, Rodríguez-Sotillo A, Ferreiro-Velasco M, Salvador-de la Barrera S, Montoto-Marqués A. Valor pronóstico de la resonancia magnética precoz en la morbilidad y mortalidad de la lesión medular traumática. Med Intensiva 2022. [DOI: 10.1016/j.medin.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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19
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Taran S, McCredie VA, Goligher EC. Noninvasive and invasive mechanical ventilation for neurologic disorders. HANDBOOK OF CLINICAL NEUROLOGY 2022; 189:361-386. [PMID: 36031314 DOI: 10.1016/b978-0-323-91532-8.00015-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Patients with acute neurologic injuries frequently require mechanical ventilation due to diminished airway protective reflexes, cardiopulmonary failure secondary to neurologic insults, or to facilitate gas exchange to precise targets. Mechanical ventilation enables tight control of oxygenation and carbon dioxide levels, enabling clinicians to modulate cerebral hemodynamics and intracranial pressure with the goal of minimizing secondary brain injury. In patients with acute spinal cord injuries, neuromuscular conditions, or diseases of the peripheral nerve, mechanical ventilation enables respiratory support under conditions of impending or established respiratory failure. Noninvasive ventilatory approaches may be carefully considered for certain disease conditions, including myasthenia gravis and amyotrophic lateral sclerosis, but may be inappropriate in patients with Guillain-Barré syndrome or when relevant contra-indications exist. With regard to discontinuing mechanical ventilation, considerable uncertainty persists about the best approach to wean patients, how to identify patients ready for extubation, and when to consider primary tracheostomy. Recent consensus guidelines highlight these and other knowledge gaps that are the focus of active research efforts. This chapter outlines important general principles to consider when initiating, titrating, and discontinuing mechanical ventilation in patients with acute neurologic injuries. Important disease-specific considerations are also reviewed where appropriate.
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Affiliation(s)
- Shaurya Taran
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada; Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Victoria A McCredie
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada; Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Ewan C Goligher
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada; Department of Medicine, University Health Network, Toronto, ON, Canada.
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20
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Murphy SA, Furger R, Kurpad SN, Arpinar VE, Nencka A, Koch K, Budde MD. Filtered Diffusion-Weighted MRI of the Human Cervical Spinal Cord: Feasibility and Application to Traumatic Spinal Cord Injury. AJNR Am J Neuroradiol 2021; 42:2101-2106. [PMID: 34620590 DOI: 10.3174/ajnr.a7295] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 07/07/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE In traumatic spinal cord injury, DTI is sensitive to injury but is unable to differentiate multiple pathologies. Axonal damage is a central feature of the underlying cord injury, but prominent edema confounds its detection. The purpose of this study was to examine a filtered DWI technique in patients with acute spinal cord injury. MATERIALS AND METHODS The MR imaging protocol was first evaluated in a cohort of healthy subjects at 3T (n = 3). Subsequently, patients with acute cervical spinal cord injury (n = 8) underwent filtered DWI concurrent with their acute clinical MR imaging examination <24 hours postinjury at 1.5T. DTI was obtained with 25 directions at a b-value of 800 s/mm2. Filtered DWI used spinal cord-optimized diffusion-weighting along 26 directions with a "filter" b-value of 2000 s/mm2 and a "probe" maximum b-value of 1000 s/mm2. Parallel diffusivity metrics obtained from DTI and filtered DWI were compared. RESULTS The high-strength diffusion-weighting perpendicular to the cord suppressed signals from tissues outside of the spinal cord, including muscle and CSF. The parallel ADC acquired from filtered DWI at the level of injury relative to the most cranial region showed a greater decrease (38.71%) compared with the decrease in axial diffusivity acquired by DTI (17.68%). CONCLUSIONS The results demonstrated that filtered DWI is feasible in the acute setting of spinal cord injury and reveals spinal cord diffusion characteristics not evident with conventional DTI.
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Affiliation(s)
- S A Murphy
- From the Department of Neurosurgery (S.A.M., R.F., S.N.K., M.D.B.)
| | - R Furger
- From the Department of Neurosurgery (S.A.M., R.F., S.N.K., M.D.B.)
- Center for Neurotrauma Research (R.F., S.N.K., M.D.B.)
| | - S N Kurpad
- From the Department of Neurosurgery (S.A.M., R.F., S.N.K., M.D.B.)
- Center for Neurotrauma Research (R.F., S.N.K., M.D.B.)
| | - V E Arpinar
- Center for Imaging Research (V.E.A., A.N., K.K.), Medical College of Wisconsin, Milwaukee, Wisconsin
| | - A Nencka
- Center for Imaging Research (V.E.A., A.N., K.K.), Medical College of Wisconsin, Milwaukee, Wisconsin
| | - K Koch
- Center for Imaging Research (V.E.A., A.N., K.K.), Medical College of Wisconsin, Milwaukee, Wisconsin
| | - M D Budde
- From the Department of Neurosurgery (S.A.M., R.F., S.N.K., M.D.B.)
- Center for Neurotrauma Research (R.F., S.N.K., M.D.B.)
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21
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Leister I, Altendorfer B, Maier D, Mach O, Wutte C, Grillhösl A, Arevalo-Martin A, Garcia-Ovejero D, Aigner L, Grassner L. Serum Levels of Glial Fibrillary Acidic Protein and Neurofilament Light Protein Are Related to the Neurological Impairment and Spinal Edema after Traumatic Spinal Cord Injury. J Neurotrauma 2021; 38:3431-3439. [PMID: 34541888 DOI: 10.1089/neu.2021.0264] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Neurological examination in the acute phase after spinal cord injury (SCI) is often impossible and severely confounded by pharmacological sedation or concomitant injuries. Therefore, diagnostic biomarkers that objectively characterize severity or the presence of SCI are urgently needed to facilitate clinical decision-making. This study aimed to determine if serum markers of neural origin are related to: 1) presence and severity of SCI, and 2) magnetic resonance imaging (MRI) parameters in the very acute post-injury phase. We performed a secondary analysis of serological parameters, as well as MRI findings in patients with acute SCI (n = 38). Blood samples were collected between Days 1-4 post-injury. Serum protein levels of glial fibrillary acidic protein (GFAP), neuron-specific enolase (NSE), and neurofilament light protein (NfL) were determined. A group of 41 age- and sex-matched healthy individuals served as control group. In the group of individuals with SCI, pre-operative sagittal and axial T2-weighted and sagittal T1-weighted MRI scans were available for 21 patients. Serum markers of neural origin are different among individuals who sustained traumatic SCI depending on injury severity, and the extent of the lesion according to MRI in the acute injury phase. Unbiased Recursive Partitioning regression with Conditional Inference Trees (URP-CTREE) produced preliminary cut-off values for NfL (75.217 pg/mL) and GFAP (73.121 pg/mL), allowing a differentiation between individuals with SCI and healthy controls within the first 4 days after SCI. Serum proteins NfL and GFAP qualify as diagnostic biomarkers for the presence and severity of SCI in the acute post-injury phase, where the reliability of clinical exams is limited.
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Affiliation(s)
- Iris Leister
- ParaMove, SCI Research Unit, BG Trauma Center Murnau, Murnau, Germany, and Paracelsus Medical University, Salzburg, Austria.,Spinal Cord Injury Center, Clinical Research Unit, Neuroradiology and Interventional Radiology, BG Trauma Center Murnau, Murnau, Germany.,Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, Salzburg, Austria
| | - Barbara Altendorfer
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, Salzburg, Austria
| | - Doris Maier
- ParaMove, SCI Research Unit, BG Trauma Center Murnau, Murnau, Germany, and Paracelsus Medical University, Salzburg, Austria
| | - Orpheus Mach
- ParaMove, SCI Research Unit, BG Trauma Center Murnau, Murnau, Germany, and Paracelsus Medical University, Salzburg, Austria.,Spinal Cord Injury Center, Clinical Research Unit, Neuroradiology and Interventional Radiology, BG Trauma Center Murnau, Murnau, Germany
| | - Christof Wutte
- Department of Neurosurgery, Neuroradiology and Interventional Radiology, BG Trauma Center Murnau, Murnau, Germany.,Institute of Biomechanics, BG Trauma Center Murnau, Germany, and Paracelsus Medical University, Salzburg, Austria
| | - Andreas Grillhösl
- Department of Radiology, Neuroradiology and Interventional Radiology, BG Trauma Center Murnau, Murnau, Germany
| | - Angel Arevalo-Martin
- Laboratory of Neuroinflammation, Hospital Nacional de Paraplejicos, SESCAM, Toledo, Spain
| | - Daniel Garcia-Ovejero
- Laboratory of Neuroinflammation, Hospital Nacional de Paraplejicos, SESCAM, Toledo, Spain
| | - Ludwig Aigner
- ParaMove, SCI Research Unit, BG Trauma Center Murnau, Murnau, Germany, and Paracelsus Medical University, Salzburg, Austria.,Spinal Cord Injury Center, Clinical Research Unit, Neuroradiology and Interventional Radiology, BG Trauma Center Murnau, Murnau, Germany.,Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, Salzburg, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Lukas Grassner
- ParaMove, SCI Research Unit, BG Trauma Center Murnau, Murnau, Germany, and Paracelsus Medical University, Salzburg, Austria.,Spinal Cord Injury Center, Clinical Research Unit, Neuroradiology and Interventional Radiology, BG Trauma Center Murnau, Murnau, Germany.,Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, Salzburg, Austria.,Department of Neurosurgery, Neuroradiology and Interventional Radiology, BG Trauma Center Murnau, Murnau, Germany.,Institute of Biomechanics, BG Trauma Center Murnau, Germany, and Paracelsus Medical University, Salzburg, Austria.,Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
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Boruah DK, Hazarika K, Borah KK, Ahmed H, Sharma BK. Added Value of Three-Plane Multiecho Fast Field Echo MRI Sequence in the Evaluation of Acute Spinal Trauma Using Sensitivity: A Prospective Study. Cureus 2021; 13:e14694. [PMID: 34055538 PMCID: PMC8153967 DOI: 10.7759/cureus.14694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Multiecho fast field echo (mFFE) MRI sequence provides added value to the conventional MR imaging in evaluation of acute spinal trauma, especially for detecting spinal cord hemorrhage which is a best predictor for patient prognosis. Objective This study aims to evaluate the diagnostic efficacies of three-plane mFFE MRI sequence along with the conventional MRI sequences in acute spinal trauma patients using sensitivity. Materials and methods This prospective study comprised of 48 patients of acute spinal trauma. The neurological deficit of acute spinal trauma patients assessed according to the American Spine Injury Association (ASIA) scale. The correlation between the various MRI findings of acute spinal cord injury and neurological deficits were compared with the Chi-square test. Results Of 48 patients of acute spinal trauma, 36 males and 12 females with a mean age of 38.71±1.42 [SD] years. 22 (45.8%) patients had cord edema with a mean length of was 3.45±5.52 [SD] cm. The mean percentage of spinal canal compromisation was 39.47±25.47 [SD] and spinal cord compression 18.1±24.4 [SD]. There was statistical significance between the ASIA impairment scale and spinal canal compromisation and cord compression with a p-value of 0.0005. Cord hemorrhage observed in 13 (27%), non-hemorrhagic cord contusions in 3 (6.3%), cord transection in 5 (10.4%) and epidural hematoma in 10 (20.8%) patients with an initial high grade of ASIA scale. The visibility score of three-plane mFFE sequence was higher in comparison to the single plane sagittal mFFE and short tau inversion recovery (STIR) sequences. For detection of spinal cord hemorrhage with visibility score of 2, the three-plane mFFE had sensitivity of 77% followed by 38.5% with single plane sagittal mFFE and 7.7% with sagittal STIR images. 26 (54.2%) patients showed neurological improvement in their hospital stay/follow-up period and no improvement observed in 7 (14.6%) patients of acute spinal trauma. Conclusions Application of three-plane mFFE sequences detects more spinal cord hemorrhages and vertebral fractures with a better visibility score as compared to the single sagittal plane mFFE and STIR sequence.
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Affiliation(s)
- Deb K Boruah
- Radiodiagnosis, Tezpur Medical College, Tezpur, IND
| | | | | | | | - Barun K Sharma
- Radiodiagnosis, Sikkim Manipal Institute of Medical Science, Gangtok, IND
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Dutil GF, Schweizer D, Oevermann A, Stein VM, Maiolini A. Haematomyelia and myelomalacia following an inadvertent thoracic intraspinal injection in a cat. JFMS Open Rep 2021; 7:2055116921995394. [PMID: 33796326 PMCID: PMC7968032 DOI: 10.1177/2055116921995394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Case summary A 4-month-old cat was presented with acute paraplegia after the referring veterinarian performed a subcutaneous injection (cefovecin and dexamethasone) in the caudodorsal thoracic area, during which the cat suddenly became uncooperative. A complete neurological examination performed 1 day after the injection revealed paraplegia without deep pain perception and reduced segmental spinal reflexes in the pelvic limbs. Findings were consistent with either an L4–S3 myelopathy or a T3–L3 myelopathy with subsequent spinal shock. MRI showed swelling of the spinal cord from T1 to L1 with heterogeneous T2-weighted intramedullary hyperintensity and no contrast enhancement. A centrally located intraspinal signal void was visible in T2*-weighted images. These changes were compatible with a suspected traumatic intraspinal injection. Despite intensive supportive care over 4 days, neurological status did not improve and the cat was euthanased. Gross pathology findings revealed severe intramedullary haemorrhage and myelomalacia in the T10–L1 spinal cord segments. Histopathology of the spinal cord after haematoxylin and eosin staining revealed a severe intramedullary space-occupying haemorrhage with focal malacia. A trajectory-like, optically empty cavity containing some eosinophilic droplets at the edges was detected. Although no further evidence of trauma was noted in the surrounding structures, the spinal cord changes were compatible with a perforating trauma. Relevance and novel information To our knowledge, this is the first report of thoracic intraspinal injection causing myelomalacia defined by an ante-mortem MRI and confirmed post mortem by histopathology. The traumatic myelopathy appeared to be most compatible with an intraspinal injection causing vascular rupture.
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Affiliation(s)
- Guillaume F Dutil
- Division of Clinical Neurology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Daniela Schweizer
- Division of Clinical Radiology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Anna Oevermann
- Division of Neurological Sciences, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Veronika M Stein
- Division of Clinical Neurology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Arianna Maiolini
- Division of Clinical Neurology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
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24
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Mathew M, Mezue WC, Chikani MC, Jimoh AO, Uche EO, Mathew MB. Correlation of Quantitative MRI Parameters with Neurological Outcome in Acute Cervical Spinal Cord Injury. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2021; 11:5-10. [PMID: 35873875 PMCID: PMC9302387 DOI: 10.4103/jwas.jwas_52_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/12/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The unbearable morbidity and significant mortality associated with traumatic cervical spine injuries (T-CSIs) have been complicated by difficulties in outcome prediction. OBJECTIVES This study aims to determine the correlation between quantitative magnetic resonance imaging (MRI) parameters and neurological outcome among patients with acute T-CSI. MATERIALS AND METHODS This is a prospective study in which patients with T-CSI were recruited over a 12-month period. ASIA Impairment Scale (AIS) at admission, 6 weeks, and 3 months was assessed. Mean spinal cord compression (MSCC), mean canal compromise (MCC), and length of lesion (LOL) were calculated from MRI at admission, and correlation with neurological severity and outcome was determined. The data were analysed using SPSS version 21. A P-value of less than 0.05 was considered significant for associations. RESULTS Sixty-nine patients were enrolled comprising 55 males and 14 females giving a male-female ratio of 4.9:1. Their ages ranged from 18 to 74 years with a mean age of 40.2 ± 15.1 years. Injuries were ASIA A in 55.1% and ASIA E in 7.2% on admission. The mean MSCC, MCC, and LOL were higher for ASIA A and B and lowest in ASIA E injuries. Patients with good AIS (D and E) had significantly lower MSCC on admission (P = 0.032) and at 6 weeks (P = 0.000), and the LOL was also lower on admission (P = 0.000), at 6 weeks (P = 0.006), and at 3 months (P = 0.007). None of MRI parameters predicted outcome. CONCLUSION The MSCC, MCC, and LOL correlate with T-CSI severity but were not sufficient to predict outcome.
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Affiliation(s)
- Mesi Mathew
- Surgery Department, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Wilfred C. Mezue
- Surgery Department, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Mark C. Chikani
- Surgery Department, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Abdullahi O. Jimoh
- Surgery Department, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Enoch O. Uche
- Surgery Department, University of Nigeria Teaching Hospital, Enugu, Nigeria
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Ren Z, Qi Y, Sun S, Tao Y, Shi R. Mesenchymal Stem Cell-Derived Exosomes: Hope for Spinal Cord Injury Repair. Stem Cells Dev 2020; 29:1467-1478. [PMID: 33045910 DOI: 10.1089/scd.2020.0133] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Spinal cord injury (SCI) is a devastating medical condition with profound social and economic impacts. Although research is ongoing, current treatment options are limited and do little to restore functionality. However, recent studies suggest that mesenchymal stem cell-derived exosomes (MSC-exosomes) may hold the key to exciting new treatment options for SCI patients. MSCs are self-renewing multipotent stem cells with multi-directional differentiation and can secrete a large number of exosomes (vesicles secreted into the extracellular environment through endocytosis, called MSC-exosomes). These MSC-exosomes play a critical role in repairing SCI through promoting angiogenesis and axonal growth, regulating inflammation and the immune response, inhibiting apoptosis, and maintaining the integrity of the blood-spinal cord barrier. Furthermore, they can be utilized to transport genetic material or drugs to target cells, and their relatively small size makes them able to permeate the blood-brain barrier. In this review, we summarize recent advances in MSC-exosome themed SCI treatments and cell-free therapies to better understand this newly emerging methodology.
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Affiliation(s)
- Zhihua Ren
- Department of Basic Medical Sciences, College of Veterinary Medicine, Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA.,Key Laboratory of Animal Disease and Human Health of Sichuan Province, College of Veterinary Medicine, Sichuan Agricultural University, Yaan, China
| | - Yao Qi
- Key Laboratory of Animal Disease and Human Health of Sichuan Province, College of Veterinary Medicine, Sichuan Agricultural University, Yaan, China
| | - Siyuan Sun
- Department of Basic Medical Sciences, College of Veterinary Medicine, Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA.,Department of Orthopedics, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuanyuan Tao
- Department of Basic Medical Sciences, College of Veterinary Medicine, Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA.,Key Laboratory of Animal Disease and Human Health of Sichuan Province, College of Veterinary Medicine, Sichuan Agricultural University, Yaan, China
| | - Riyi Shi
- Department of Basic Medical Sciences, College of Veterinary Medicine, Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA
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Response to “Spontaneous acute epidural haematoma of the cervical spine with an atypical onset resembling ictal symptom”. NEUROLOGÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.nrleng.2018.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Martinez-Perez R, Rayo N. Respuesta a «Hematoma epidural agudo cervical espontáneo de inicio atípico simulando cuadro ictal». Neurologia 2020; 35:507-508. [DOI: 10.1016/j.nrl.2018.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 12/22/2018] [Indexed: 10/27/2022] Open
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Hale C, Yonan J, Batarseh R, Chaar R, Jonak CR, Ge S, Binder D, Rodgers VGJ. Implantable Osmotic Transport Device Can Reduce Edema After Severe Contusion Spinal Cord Injury. Front Bioeng Biotechnol 2020; 8:806. [PMID: 32754586 PMCID: PMC7366393 DOI: 10.3389/fbioe.2020.00806] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 06/23/2020] [Indexed: 12/30/2022] Open
Abstract
Recent findings from the ISCoPe study indicate that, after severe contusion to the spinal cord, edema originating in the spinal cord accumulates and compresses the tissue against the surrounding dura mater, despite decompressive laminectomy. It is hypothesized that this compression results in restricted flow of cerebrospinal fluid (CSF) in the subarachnoid space and central canal and ultimately collapses local vasculature, exacerbating ischemia and secondary injury. Here we developed a surgically mounted osmotic transport device (OTD) that rests on the dura and can osmotically remove excess fluid at the injury site. Tests were performed in 4-h studies immediately following severe (250 kD) contusion at T8 in rats using the OTD. A 3-h treatment with the OTD after 1-h post injury significantly reduced spinal cord edema compared to injured controls. A first approximation mathematical interpretation implies that this modest reduction in edema may be significant enough to relieve compression of local vasculature and restore flow of CSF in the region. In addition, we determined the progression of edema up to 28 days after insult in the rat for the same injury model. Results showed peak edema at 72 h. These preliminary results suggest that incorporating the OTD to operate continuously at the site of injury throughout the critical period of edema progression, the device may significantly improve recovery following contusion spinal cord injury.
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Affiliation(s)
- Christopher Hale
- Department of Bioengineering, University of California, Riverside, Riverside, CA, United States
| | - Jennifer Yonan
- Division of Biomedical Sciences, School of Medicine, University of California, Riverside, Riverside, CA, United States
| | - Ramsey Batarseh
- Department of Bioengineering, University of California, Riverside, Riverside, CA, United States
| | - Roman Chaar
- Department of Bioengineering, University of California, Riverside, Riverside, CA, United States
| | - Carrie R Jonak
- Division of Biomedical Sciences, School of Medicine, University of California, Riverside, Riverside, CA, United States
| | - Shaokui Ge
- Division of Biostatistics & Bioinformatics, School of Medicine, University of California, Riverside, Riverside, CA, United States
| | - Devin Binder
- Division of Biomedical Sciences, School of Medicine, University of California, Riverside, Riverside, CA, United States
| | - Victor G J Rodgers
- Department of Bioengineering, University of California, Riverside, Riverside, CA, United States
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Martinez-Perez R, Rayo N. Letter to the Editor Regarding “Influence of Preoperative Magnetic Resonance Imaging on Surgical Decision Making for Patients with Acute Traumatic Cervical Spinal Cord Injury: A Survey Among Experienced Spine Surgeons”. World Neurosurg 2020; 137:476-477. [DOI: 10.1016/j.wneu.2019.11.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 11/23/2019] [Indexed: 10/24/2022]
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Naduvanahalli Vivekanandaswamy A, Kannan M, Sharma V, Shetty AP, Maheswaran A, Kanna RM, Rajasekaran S. Prognostic utility of magnetic resonance imaging (MRI) in predicting neurological outcomes in patients with acute thoracolumbar spinal cord injury. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 29:1227-1235. [PMID: 31501968 DOI: 10.1007/s00586-019-06135-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/10/2019] [Accepted: 09/03/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Utility of MRI for predicting neurological outcomes in acute cervical spinal cord injury (SCI) is well established but its value in thoracolumbar (TL) SCI needs to be evaluated. METHODS Seventy-six patients operated for acute TL spinal injuries between January 2014 and March 2016 were reviewed to obtain demographic details, neurology at admission and at the final follow-up. Patients were divided based on the neurology at presentation into group 1 (ASIA A), group 2 (ASIA B, C, D) and group 3 (normal neurology). Preoperative MRI and CT scans were evaluated to measure parameters like osseus canal compromise, spinal cord compression (SCC), spinal cord swelling, length of cord swelling (LOS), length of edema (LOE) and the presence of hemorrhage. The MRI parameters were compared between the groups for their predictive value of neurology on admission and at the final follow-up. RESULTS Of the 38 patients in group 1, six patients recovered by 1 grade, nine patients recovered by 2 grades and there was no recovery in 23 (60.5%) patients. Among group 2 patients, nine (40.9%) out of 22 recovered to ASIA E neurology. On univariate analysis, SCC (P = 0.009), LOS (P = 0.021) and length of edema (P = 0.002) were associated with complete neurological deficit at presentation. However, on multivariate regression analysis only LOE was significant (P = 0.007) in predicting neurology at admission and at follow-up. CONCLUSION Greater the rostrocaudal LOE, worse is the neurology at presentation, and it is associated with poor neurological recovery at follow-up. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
| | - Muhil Kannan
- Department of Radiodiagnosis, Ganga Medical Centre and Hospitals Pvt. Ltd, Mettupalayam Road, Coimbatore, 641001, India
| | - Vyom Sharma
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd, Mettupalayam Road, Coimbatore, 641001, India
| | - Ajoy Prasad Shetty
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd, Mettupalayam Road, Coimbatore, 641001, India. .,Department of Orthopaedics and Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd, #313, Mettupalayam Road, Coimbatore, Tamilnadu, 641001, India.
| | - Anupama Maheswaran
- Department of Radiodiagnosis, Ganga Medical Centre and Hospitals Pvt. Ltd, Mettupalayam Road, Coimbatore, 641001, India
| | - Rishi Mugesh Kanna
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd, Mettupalayam Road, Coimbatore, 641001, India
| | - Shanmuganathan Rajasekaran
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd, Mettupalayam Road, Coimbatore, 641001, India
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Izzo R, Popolizio T, Balzano RF, Pennelli AM, Simeone A, Muto M. Imaging of cervical spine traumas. Eur J Radiol 2019; 117:75-88. [DOI: 10.1016/j.ejrad.2019.05.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 05/06/2019] [Indexed: 11/28/2022]
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Seif M, Gandini Wheeler-Kingshott CA, Cohen-Adad J, Flanders AE, Freund P. Guidelines for the conduct of clinical trials in spinal cord injury: Neuroimaging biomarkers. Spinal Cord 2019; 57:717-728. [PMID: 31267015 PMCID: PMC6760553 DOI: 10.1038/s41393-019-0309-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/20/2019] [Accepted: 05/21/2019] [Indexed: 12/16/2022]
Abstract
Traumatic spinal cord injury (SCI) leads to immediate neuronal and axonal damage at the focal injury site and triggers secondary pathologic series of events resulting in sensorimotor and autonomic dysfunction below the level of injury. Although there is no cure for SCI, neuroprotective and regenerative therapies show promising results at the preclinical stage. There is a pressing need to develop non-invasive outcome measures that can indicate whether a candidate therapeutic agent or a cocktail of therapeutic agents are positively altering the underlying disease processes. Recent conventional MRI studies have quantified spinal cord lesion characteristics and elucidated their relationship between severity of injury to clinical impairment and recovery. Next to the quantification of the primary cord damage, quantitative MRI measures of spinal cord (rostrocaudally to the lesion site) and brain integrity have demonstrated progressive and specific neurodegeneration of afferent and efferent neuronal pathways. MRI could therefore play a key role to ultimately uncover the relationship between clinical impairment/recovery and injury-induced neurodegenerative changes in the spinal cord and brain. Moreover, neuroimaging biomarkers hold promises to improve clinical trial design and efficiency through better patient stratification. The purpose of this narrative review is therefore to propose a guideline of clinically available MRI sequences and their derived neuroimaging biomarkers that have the potential to assess tissue damage at the macro- and microstructural level after SCI. In this piece, we make a recommendation for the use of key MRI sequences-both conventional and advanced-for clinical work-up and clinical trials.
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Affiliation(s)
- Maryam Seif
- Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Claudia Am Gandini Wheeler-Kingshott
- Faculty of Brain Sciences, Queen Square MS Centre, UCL Queen Square Institute of Neurology, London, United Kingdom.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Brain MRI 3T Mondino Research Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Julien Cohen-Adad
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
| | - Adam E Flanders
- Regional Spinal Cord Injury Center of the Delaware Valley, Department of Radiology, Division of Neuroradiology, Thomas Jefferson University, 1087 Main Building, 132 South 10th Street, Philadelphia, PA, 19107, USA
| | - Patrick Freund
- Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Zurich, Switzerland. .,Faculty of Brain Sciences, Queen Square MS Centre, UCL Queen Square Institute of Neurology, London, United Kingdom. .,Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany. .,Department of Neurology, University Hospital Zurich, Zurich, Switzerland.
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MR Imaging for Assessing Injury Severity and Prognosis in Acute Traumatic Spinal Cord Injury. Radiol Clin North Am 2019; 57:319-339. [DOI: 10.1016/j.rcl.2018.09.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Pierce JL, Donahue JH, Nacey NC, Quirk CR, Perry MT, Faulconer N, Falkowski GA, Maldonado MD, Shaeffer CA, Shen FH. Spinal Hematomas: What a Radiologist Needs to Know. Radiographics 2018; 38:1516-1535. [DOI: 10.1148/rg.2018180099] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jennifer L. Pierce
- From the Departments of Radiology and Medical Imaging (J.L.P., J.H.D., N.C.N., C.R.Q., M.T.P., N.F., M.D.M., C.A.S.) and Orthopedic Surgery (G.A.F., F.H.S.), University of Virginia, 1215 Lee St, Charlottesville, VA 22908
| | - Joseph H. Donahue
- From the Departments of Radiology and Medical Imaging (J.L.P., J.H.D., N.C.N., C.R.Q., M.T.P., N.F., M.D.M., C.A.S.) and Orthopedic Surgery (G.A.F., F.H.S.), University of Virginia, 1215 Lee St, Charlottesville, VA 22908
| | - Nicholas C. Nacey
- From the Departments of Radiology and Medical Imaging (J.L.P., J.H.D., N.C.N., C.R.Q., M.T.P., N.F., M.D.M., C.A.S.) and Orthopedic Surgery (G.A.F., F.H.S.), University of Virginia, 1215 Lee St, Charlottesville, VA 22908
| | - Cody R. Quirk
- From the Departments of Radiology and Medical Imaging (J.L.P., J.H.D., N.C.N., C.R.Q., M.T.P., N.F., M.D.M., C.A.S.) and Orthopedic Surgery (G.A.F., F.H.S.), University of Virginia, 1215 Lee St, Charlottesville, VA 22908
| | - Michael T. Perry
- From the Departments of Radiology and Medical Imaging (J.L.P., J.H.D., N.C.N., C.R.Q., M.T.P., N.F., M.D.M., C.A.S.) and Orthopedic Surgery (G.A.F., F.H.S.), University of Virginia, 1215 Lee St, Charlottesville, VA 22908
| | - Nicholas Faulconer
- From the Departments of Radiology and Medical Imaging (J.L.P., J.H.D., N.C.N., C.R.Q., M.T.P., N.F., M.D.M., C.A.S.) and Orthopedic Surgery (G.A.F., F.H.S.), University of Virginia, 1215 Lee St, Charlottesville, VA 22908
| | - Gene A. Falkowski
- From the Departments of Radiology and Medical Imaging (J.L.P., J.H.D., N.C.N., C.R.Q., M.T.P., N.F., M.D.M., C.A.S.) and Orthopedic Surgery (G.A.F., F.H.S.), University of Virginia, 1215 Lee St, Charlottesville, VA 22908
| | - Michael D. Maldonado
- From the Departments of Radiology and Medical Imaging (J.L.P., J.H.D., N.C.N., C.R.Q., M.T.P., N.F., M.D.M., C.A.S.) and Orthopedic Surgery (G.A.F., F.H.S.), University of Virginia, 1215 Lee St, Charlottesville, VA 22908
| | - Catherine A. Shaeffer
- From the Departments of Radiology and Medical Imaging (J.L.P., J.H.D., N.C.N., C.R.Q., M.T.P., N.F., M.D.M., C.A.S.) and Orthopedic Surgery (G.A.F., F.H.S.), University of Virginia, 1215 Lee St, Charlottesville, VA 22908
| | - Francis H. Shen
- From the Departments of Radiology and Medical Imaging (J.L.P., J.H.D., N.C.N., C.R.Q., M.T.P., N.F., M.D.M., C.A.S.) and Orthopedic Surgery (G.A.F., F.H.S.), University of Virginia, 1215 Lee St, Charlottesville, VA 22908
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Skinner NP, Lee SY, Kurpad SN, Schmit BD, Muftuler LT, Budde MD. Filter-probe diffusion imaging improves spinal cord injury outcome prediction. Ann Neurol 2018; 84:37-50. [PMID: 29752739 PMCID: PMC6119508 DOI: 10.1002/ana.25260] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 05/07/2018] [Accepted: 05/07/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Diffusion-weighted imaging (DWI) is a powerful tool for investigating spinal cord injury (SCI), but has limited specificity for axonal damage, which is the most predictive feature of long-term functional outcome. In this study, a technique designed to detect acute axonal injury, filter-probe double diffusion encoding (FP-DDE), is compared with standard DWI for predicting long-term functional and cellular outcomes. METHODS This study extends FP-DDE to predict long-term functional and histological outcomes in a rat SCI model of varying severities (n = 58). Using a 9.4T magnetic resonance imaging (MRI) system, a whole-cord FP-DDE spectroscopic voxel was acquired in 3 minutes at the lesion site and compared to DWI at 48 hours postinjury. Relationships with chronic (30-day) locomotor and histological outcomes were evaluated with linear regression. RESULTS The FP-DDE measure of parallel diffusivity (ADC|| ) was significantly related to chronic hind limb locomotor functional outcome (R2 = 0.63, p < 0.0001), and combining this measurement with acute functional scores demonstrated prognostic benefit versus functional testing alone (p = 0.0007). Acute ADC|| measurements were also more closely related to the number of injured axons measured 30 days after the injury than standard DWI. Furthermore, acute FP-DDE images showed a clear and easily interpretable pattern of injury that closely corresponded with chronic MRI and histology observations. INTERPRETATION Collectively, these results demonstrate FP-DDE benefits from greater specificity for acute axonal damage in predicting functional and histological outcomes with rapid acquisition and fully automated analysis, improving over standard DWI. FP-DDE is a promising technique compatible with clinical settings, with potential research and clinical applications for evaluation of spinal cord pathology. Ann Neurol 2018;83:37-50.
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Affiliation(s)
- Nathan P Skinner
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI
- Medical Scientist Training Program, Medical College of Wisconsin, Milwaukee, WI
| | - Seung-Yi Lee
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI
- Neuroscience Doctoral Program, Medical College of Wisconsin, Milwaukee, WI
- Biophysics Graduate Program, Medical College of Wisconsin, Milwaukee, WI
| | - Shekar N Kurpad
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI
| | - Brian D Schmit
- Department of Biomedical Engineering, Marquette University, Milwaukee, WI
| | - L Tugan Muftuler
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI
| | - Matthew D Budde
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI
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Budde MD, Skinner NP, Muftuler LT, Schmit BD, Kurpad SN. Optimizing Filter-Probe Diffusion Weighting in the Rat Spinal Cord for Human Translation. Front Neurosci 2017; 11:706. [PMID: 29311786 PMCID: PMC5742102 DOI: 10.3389/fnins.2017.00706] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 12/01/2017] [Indexed: 12/15/2022] Open
Abstract
Diffusion tensor imaging (DTI) is a promising biomarker of spinal cord injury (SCI). In the acute aftermath, DTI in SCI animal models consistently demonstrates high sensitivity and prognostic performance, yet translation of DTI to acute human SCI has been limited. In addition to technical challenges, interpretation of the resulting metrics is ambiguous, with contributions in the acute setting from both axonal injury and edema. Novel diffusion MRI acquisition strategies such as double diffusion encoding (DDE) have recently enabled detection of features not available with DTI or similar methods. In this work, we perform a systematic optimization of DDE using simulations and an in vivo rat model of SCI and subsequently implement the protocol to the healthy human spinal cord. First, two complementary DDE approaches were evaluated using an orientationally invariant or a filter-probe diffusion encoding approach. While the two methods were similar in their ability to detect acute SCI, the filter-probe DDE approach had greater predictive power for functional outcomes. Next, the filter-probe DDE was compared to an analogous single diffusion encoding (SDE) approach, with the results indicating that in the spinal cord, SDE provides similar contrast with improved signal to noise. In the SCI rat model, the filter-probe SDE scheme was coupled with a reduced field of view (rFOV) excitation, and the results demonstrate high quality maps of the spinal cord without contamination from edema and cerebrospinal fluid, thereby providing high sensitivity to injury severity. The optimized protocol was demonstrated in the healthy human spinal cord using the commercially-available diffusion MRI sequence with modifications only to the diffusion encoding directions. Maps of axial diffusivity devoid of CSF partial volume effects were obtained in a clinically feasible imaging time with a straightforward analysis and variability comparable to axial diffusivity derived from DTI. Overall, the results and optimizations describe a protocol that mitigates several difficulties with DTI of the spinal cord. Detection of acute axonal damage in the injured or diseased spinal cord will benefit the optimized filter-probe diffusion MRI protocol outlined here.
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Affiliation(s)
- Matthew D. Budde
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Nathan P. Skinner
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
- Medical Scientist Training Program, Medical College of Wisconsin, Milwaukee, WI, United States
| | - L. Tugan Muftuler
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Brian D. Schmit
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI, United States
| | - Shekar N. Kurpad
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
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Tan JW, Zhang F, Liu HJ, Li Z. Hyperbaric oxygen ameliorated the lesion scope and nerve function in acute spinal cord injury patients: A retrospective study. Clin Biochem 2017; 53:1-7. [PMID: 29217422 DOI: 10.1016/j.clinbiochem.2017.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 11/29/2017] [Accepted: 12/03/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This is a retrospective study to assess the therapeutic effect of hyperbaric oxygen (HBO) in early treatment of acute spinal cord injury (SCI) using magnetic resonance imaging (MRI) and electrophysiology in diagnosing. METHODS Forty acute SCI patients from Sun Yat-Sen Memorial Hospital who were assigned into HBO treatment were included during August 2013 to October 2014.The patients with adverse reactions or contraindications for HBO were assigned as controls. Both of two groups (HBO and Control) received medicine treatment with Urbason, GM-1 and mecobalamine after surgery. ASIA and the Frankel scores were used to evaluate the therapeutic effect of HBO at the 15th and 30th day after HBO treatment by using MRI and electrophysiology features. RESULTS Significant therapeutic effect of HBO treatment on acute SCI patients was observed compared with the control group (P<0.05). Comparison for ASIA and Frankel scores showed that motor and neurological functions were significantly improved in HBO group at day 15 and day 30 post treatment. MRI images showed that the grade III injury in HBO group was significant lower than the control group. In comparison with the control, the peak of somatosensory evoked potential (SEP) and motor evoked potential (MEP) amplitude increased, the latency was shortened, and the conduction velocity of sensory nerve (SCV) and motor nerve (MCV) was significantly increased in the HBO group (P<0.05). CONCLUSIONS HBO treatment has a great efficacy in acute SCI patients. HBO therapy at early stage of acute SCI is beneficiary to the recovery.
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Affiliation(s)
- Jie-Wen Tan
- Department of Rehabilitation Medicine, XinHua College, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, China
| | - Fang Zhang
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, China
| | - He-Jun Liu
- Department of Rehabilitation Medicine, XinHua College, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, China
| | - Zhuo Li
- Department of Hyperbaric Oxygen, Beijing Chaoyang Hospital Affiliated to Capital University of Medical Science, China.
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Grassner L, Grillhösl A, Griessenauer CJ, Thomé C, Bühren V, Strowitzki M, Winkler PA. Spinal Meninges and Their Role in Spinal Cord Injury: A Neuroanatomical Review. J Neurotrauma 2017; 35:403-410. [PMID: 28922957 DOI: 10.1089/neu.2017.5215] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Current recommendations support early surgical decompression and blood pressure augmentation after traumatic spinal cord injury (SCI). Elevated intraspinal pressure (ISP), however, has probably been underestimated in the pathophysiology of SCI. Recent studies provide some evidence that ISP measurements and durotomy may be beneficial for individuals suffering from SCI. Compression of the spinal cord against the meninges in SCI patients causes a "compartment-like" syndrome. In such cases, intentional durotomy with augmentative duroplasty to reduce ISP and improve spinal cord perfusion pressure (SCPP) may be indicated. Prior to performing these procedures routinely, profound knowledge of the spinal meninges is essential. Here, we provide an in-depth review of relevant literature along with neuroanatomical illustrations and imaging correlates.
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Affiliation(s)
- Lukas Grassner
- 1 Department of Neurosurgery, Trauma Center Murnau , Germany .,2 Center for Spinal Cord Injuries, Trauma Center Murnau , Germany .,3 Institute of Molecular Regenerative Medicine, Paracelsus Medical University , Salzburg, Austria .,4 Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University , Salzburg, Austria
| | | | - Christoph J Griessenauer
- 6 Department of Neurosurgery, Geisinger Health System , Danville, Pennsylvania.,7 Neurosurgical Service, Department of Surgery, Harvard Medical School , Boston, Massachusetts
| | - Claudius Thomé
- 8 Department of Neurosurgery, Medical University Innsbruck , Austria
| | - Volker Bühren
- 2 Center for Spinal Cord Injuries, Trauma Center Murnau , Germany
| | | | - Peter A Winkler
- 9 Department of Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University , Salzburg, Austria
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Spain JA, Cressman S, Marin H, Patel SC, Corrigan JJ, Griffith B. Cord Topographical Anatomy and its Role in Evaluating Intramedullary Lesions. Curr Probl Diagn Radiol 2017; 47:437-444. [PMID: 29054315 DOI: 10.1067/j.cpradiol.2017.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 09/06/2017] [Accepted: 09/15/2017] [Indexed: 12/13/2022]
Abstract
Intramedullary spinal lesions present a wide differential diagnosis including infectious, inflammatory, traumatic, ischemic, benign, or malignant neoplastic etiologies. Using knowledge of anatomy and physiology within the spinal cord, many similar appearing entities can be parsed into a prioritized differential. The purpose of this article is to review anatomy and pathophysiology of the spinal cord, with subsequent discussion of how this knowledge can be used to differentiate several similar appearing intramedullary pathologic processes. Discussion includes the pathophysiology, imaging findings, and clinical pearls of several intramural lesions including infarct, demyelinating lesions, traumatic injury, neoplasm, vascular malformation, and metabolic processes such as subacute combined degeneration.
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Affiliation(s)
| | - Scott Cressman
- Department of Radiology, Henry Ford Health System, Detroit, MI
| | - Horia Marin
- Department of Radiology, Henry Ford Health System, Detroit, MI
| | - Suresh C Patel
- Department of Radiology, Henry Ford Health System, Detroit, MI
| | - John J Corrigan
- Department of Radiology, Henry Ford Health System, Detroit, MI
| | - Brent Griffith
- Department of Radiology, Henry Ford Health System, Detroit, MI.
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Kurpad S, Martin AR, Tetreault LA, Fischer DJ, Skelly AC, Mikulis D, Flanders A, Aarabi B, Mroz TE, Tsai EC, Fehlings MG. Impact of Baseline Magnetic Resonance Imaging on Neurologic, Functional, and Safety Outcomes in Patients With Acute Traumatic Spinal Cord Injury. Global Spine J 2017; 7:151S-174S. [PMID: 29164022 PMCID: PMC5684848 DOI: 10.1177/2192568217703666] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVE To perform a systematic review to evaluate the utility of magnetic resonance imaging (MRI) in patients with acute spinal cord injury (SCI). METHODS An electronic search of Medline, EMBASE, the Cochrane Collaboration Library, and Google Scholar was conducted for literature published through May 12, 2015, to answer key questions associated with the use of MRI in patients with acute SCI. RESULTS The literature search yielded 796 potentially relevant citations, 8 of which were included in this review. One study used MRI in a protocol to decide on early surgical decompression. The MRI-protocol group showed improved outcomes; however, the quality of evidence was deemed very low due to selection bias. Seven studies reported MRI predictors of neurologic or functional outcomes. There was moderate-quality evidence that longer intramedullary hemorrhage (2 studies) and low-quality evidence that smaller spinal canal diameter at the location of maximal spinal cord compression and the presence of cord swelling are associated with poor neurologic recovery. There was moderate-quality evidence that clinical outcomes are not predicted by SCI lesion length and the presence of cord edema. CONCLUSIONS Certain MRI characteristics appear to be predictive of outcomes in acute SCI, including length of intramedullary hemorrhage (moderate-quality evidence), canal diameter at maximal spinal cord compression (low-quality evidence), and spinal cord swelling (low-quality evidence). Other imaging features were either inconsistently (presence of hemorrhage, maximal canal compromise, and edema length) or not associated with outcomes. The paucity of literature highlights the need for well-designed prospective studies.
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Affiliation(s)
| | - Allan R. Martin
- University of Toronto, Toronto, Ontario, Canada,Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | | | | | | | - David Mikulis
- University of Toronto, Toronto, Ontario, Canada,Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | | | | | | | - Eve C. Tsai
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada,University of Ottawa, Ottawa, Ontario, Canada
| | - Michael G. Fehlings
- University of Toronto, Toronto, Ontario, Canada,Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada,Michael G. Fehlings, MD, PhD, FRCSC, FACS, Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst Street (SCI-CRU, 11th Floor McLaughlin Pavilion), Toronto, Ontario M5T 2S8, Canada.
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Fehlings MG, Martin AR, Tetreault LA, Aarabi B, Anderson P, Arnold PM, Brodke D, Burns AS, Chiba K, Dettori JR, Furlan JC, Hawryluk G, Holly LT, Howley S, Jeji T, Kalsi-Ryan S, Kotter M, Kurpad S, Kwon BK, Marino RJ, Massicotte E, Merli G, Middleton JW, Nakashima H, Nagoshi N, Palmieri K, Singh A, Skelly AC, Tsai EC, Vaccaro A, Wilson JR, Yee A, Harrop JS. A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Role of Baseline Magnetic Resonance Imaging in Clinical Decision Making and Outcome Prediction. Global Spine J 2017; 7:221S-230S. [PMID: 29164028 PMCID: PMC5684845 DOI: 10.1177/2192568217703089] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION The objective of this guideline is to outline the role of magnetic resonance imaging (MRI) in clinical decision making and outcome prediction in patients with traumatic spinal cord injury (SCI). METHODS A systematic review of the literature was conducted to address key questions related to the use of MRI in patients with traumatic SCI. This review focused on longitudinal studies that controlled for baseline neurologic status. A multidisciplinary Guideline Development Group (GDG) used this information, their clinical expertise, and patient input to develop recommendations on the use of MRI for SCI patients. Based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation), a strong recommendation is worded as "we recommend," whereas a weaker recommendation is indicated by "we suggest." RESULTS Based on the limited available evidence and the clinical expertise of the GDG, our recommendations were: (1) "We suggest that MRI be performed in adult patients with acute SCI prior to surgical intervention, when feasible, to facilitate improved clinical decision-making" (quality of evidence, very low) and (2) "We suggest that MRI should be performed in adult patients in the acute period following SCI, before or after surgical intervention, to improve prediction of neurologic outcome" (quality of evidence, low). CONCLUSIONS These guidelines should be implemented into clinical practice to improve outcomes and prognostication for patients with SCI.
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Affiliation(s)
- Michael G. Fehlings
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
- Michael G. Fehlings, MD, PhD, FRCSC, FACS, Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst Street (SCI-CRU, 11th Floor McLaughlin Pavilion), Toronto, Ontario M5T 2S8, Canada.
| | - Allan R. Martin
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Lindsay A. Tetreault
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- University College Cork, Cork, Ireland
| | | | | | - Paul M. Arnold
- University of Kansas Medical Center, The University of Kansas, Kansas City, KS, USA
| | | | - Anthony S. Burns
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | | | | | - Julio C. Furlan
- University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | | | | | - Susan Howley
- Christopher & Dana Reeve Foundation, Short Hills, NJ, USA
| | - Tara Jeji
- Ontario Neurotrauma Foundation, Toronto, Ontario, Canada
| | | | | | | | - Brian K. Kwon
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Eric Massicotte
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Geno Merli
- Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | | | | | - Narihito Nagoshi
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Keio University, Keio, Japan
| | | | - Anoushka Singh
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | | | - Eve C. Tsai
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Jefferson R. Wilson
- University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Albert Yee
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Ziemba AM, Gilbert RJ. Biomaterials for Local, Controlled Drug Delivery to the Injured Spinal Cord. Front Pharmacol 2017; 8:245. [PMID: 28539887 PMCID: PMC5423911 DOI: 10.3389/fphar.2017.00245] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 04/19/2017] [Indexed: 11/13/2022] Open
Abstract
Affecting approximately 17,000 new people each year, spinal cord injury (SCI) is a devastating injury that leads to permanent paraplegia or tetraplegia. Current pharmacological approaches are limited in their ability to ameliorate this injury pathophysiology, as many are not delivered locally, for a sustained duration, or at the correct injury time point. With this review, we aim to communicate the importance of combinatorial biomaterial and pharmacological approaches that target certain aspects of the dynamically changing pathophysiology of SCI. After reviewing the pathophysiology timeline, we present experimental biomaterial approaches to provide local sustained doses of drug. In this review, we present studies using a variety of biomaterials, including hydrogels, particles, and fibers/conduits for drug delivery. Subsequently, we discuss how each may be manipulated to optimize drug release during a specific time frame following SCI. Developing polymer biomaterials that can effectively release drug to target specific aspects of SCI pathophysiology will result in more efficacious approaches leading to better regeneration and recovery following SCI.
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Affiliation(s)
| | - Ryan J. Gilbert
- Department of Biomedical Engineering and Center for Biotechnology and Interdisciplinary Sciences, Rensselaer Polytechnic Institute, TroyNY, USA
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MRI Prognostication Factors in the Setting of Cervical Spinal Cord Injury Secondary to Trauma. World Neurosurg 2017; 101:623-632. [DOI: 10.1016/j.wneu.2017.02.034] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 02/06/2017] [Accepted: 02/07/2017] [Indexed: 11/18/2022]
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A prospective serial MRI study following acute traumatic cervical spinal cord injury. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 26:2324-2332. [DOI: 10.1007/s00586-017-5097-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 03/17/2017] [Accepted: 04/10/2017] [Indexed: 11/26/2022]
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Grillhoesl A. Expert's comment concerning Grand Rounds case entitled "Acute complete paraplegia of a 8-year-old girl caused by spinal cord infarction following minor trauma complicated with longitudinal signal change of spinal cord" by K. Nagata et al. (Eur Spine J, 2017: doi:10.1007/s00586-017-4995-9). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 26:1436-1437. [PMID: 28409289 DOI: 10.1007/s00586-017-5047-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 03/08/2017] [Indexed: 12/16/2022]
Affiliation(s)
- Andreas Grillhoesl
- Sektion Neuroradiologie, Berufsgenossenschaftliche Unfallklinik Murnau, Prof.-Küntscher-Str. 8, 82418, Murnau am Staffelsee, Germany.
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48
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Increased intrathecal pressure after traumatic spinal cord injury: an illustrative case presentation and a review of the literature. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 26:20-25. [PMID: 27652674 DOI: 10.1007/s00586-016-4769-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 08/15/2016] [Accepted: 09/02/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Early surgical management after traumatic spinal cord injury (SCI) is nowadays recommended. Since posttraumatic ischemia is an important sequel after SCI, maintenance of an adequate mean arterial pressure (MAP) within the first week remains crucial in order to warrant sufficient spinal cord perfusion. However, the contribution of raised intraparenchymal and consecutively increased intrathecal pressure has not been implemented in treatment strategies. METHODS Case report and review of the literature. RESULTS Here we report a case of a 54-year old man who experienced a thoracic spinal cord injury after a fall. CT-examination revealed complex fractures of the thoracic spine. The patient underwent prompt surgical intervention. Intraoperatively, fractured parts of the ascending Th5 facet joint were displaced into the spinal cord itself. Upon removal, excessive protruding of medullary tissue was observed over several minutes. This demonstrates the clinical relevance of increased intrathecal pressure in some patients. CONCLUSION Monitoring and counteracting raised intrathecal pressure should guide clinical decision-making in the future in order to ensure optimal spinal cord perfusion pressure for every affected individual.
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Malhotra A, Wu X, Kalra VB, Nardini HKG, Liu R, Abbed KM, Forman HP. Utility of MRI for cervical spine clearance after blunt traumatic injury: a meta-analysis. Eur Radiol 2016; 27:1148-1160. [PMID: 27334017 DOI: 10.1007/s00330-016-4426-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 04/20/2016] [Accepted: 05/20/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To quantify the rate of unstable injuries detected by MRI missed on CT in blunt cervical spine (CS) trauma patients and assess the utility of MRI in CS clearance. METHODS We undertook a systematic review of worldwide evidence across five major medical databases and performed a meta-analysis. Studies were included if they reported the number of unstable injuries or gave enough details for inference. Variables assessed included severity, CT/MRI specifications, imaging timing, and outcome/follow-up. Pooled incidences of unstable injury on follow-up weighted by inverse-of-variance among all included and obtunded or alert patients were reported. RESULTS Of 428 unique citations, 23 proved eligible, with 5,286 patients found, and 16 unstable injuries reported in five studies. The overall pooled incidence is 0.0029 %. Among studies reporting only obtunded patients, the pooled incidence is 0.017 %. In alert patients, the incidence is 0.011 %. All reported positive findings were critically reviewed, and only 11 could be considered truly unstable. CONCLUSIONS There is significant heterogeneity in the literature regarding the use of imaging after a negative CT. The finding rate on MRI for unstable injury is extremely low in obtunded and alert patients. Although MRI is frequently performed, its utility and cost-effectiveness needs further study. KEY POINTS • There were 16 unstable injuries on follow-up MRI among 5286 patients. • The positive finding rate among obtunded patients was 0.12 %. • The positive finding rate among alert, awake patients was 0.72 %. • MRI has a high false-positive rate; its utility mandates further studies. • The use and role of "confirmatory" tests shows wide variations.
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Affiliation(s)
- Ajay Malhotra
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Tompkins East 2, 333 Cedar St, Box 208042, New Haven, CT, 06520-8042, USA.
| | - Xiao Wu
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Tompkins East 2, 333 Cedar St, Box 208042, New Haven, CT, 06520-8042, USA
| | - Vivek B Kalra
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Tompkins East 2, 333 Cedar St, Box 208042, New Haven, CT, 06520-8042, USA
| | - Holly K Grossetta Nardini
- Research and Education Librarian, Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, USA
| | - Renu Liu
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Tompkins East 2, 333 Cedar St, Box 208042, New Haven, CT, 06520-8042, USA
| | - Khalid M Abbed
- Minimally Invasive Spine Surgery & Spine Tumor Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Howard P Forman
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Tompkins East 2, 333 Cedar St, Box 208042, New Haven, CT, 06520-8042, USA
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Mabray MC, Talbott JF, Whetstone WD, Dhall SS, Phillips DB, Pan JZ, Manley GT, Bresnahan JC, Beattie MS, Haefeli J, Ferguson AR. Multidimensional Analysis of Magnetic Resonance Imaging Predicts Early Impairment in Thoracic and Thoracolumbar Spinal Cord Injury. J Neurotrauma 2016; 33:954-62. [PMID: 26414451 PMCID: PMC4876497 DOI: 10.1089/neu.2015.4093] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Literature examining magnetic resonance imaging (MRI) in acute spinal cord injury (SCI) has focused on cervical SCI. Reproducible systems have been developed for MRI-based grading; however, it is unclear how they apply to thoracic SCI. Our hypothesis is that MRI measures will group as coherent multivariate principal component (PC) ensembles, and that distinct PCs and individual variables will show discriminant validity for predicting early impairment in thoracic SCI. We undertook a retrospective cohort study of 25 patients with acute thoracic SCI who underwent MRI on admission and had American Spinal Injury Association Impairment Scale (AIS) assessment at hospital discharge. Imaging variables of axial grade, sagittal grade, length of injury, thoracolumbar injury classification system (TLICS), maximum canal compromise (MCC), and maximum spinal cord compression (MSCC) were collected. We performed an analytical workflow to detect multivariate PC patterns followed by explicit hypothesis testing to predict AIS at discharge. All imaging variables loaded positively on PC1 (64.3% of variance), which was highly related to AIS at discharge. MCC, MSCC, and TLICS also loaded positively on PC2 (22.7% of variance), while variables concerning cord signal abnormality loaded negatively on PC2. PC2 was highly related to the patient undergoing surgical decompression. Variables of signal abnormality were all negatively correlated with AIS at discharge with the highest level of correlation for axial grade as assessed with the Brain and Spinal Injury Center (BASIC) score. A multiple variable model identified BASIC as the only statistically significant predictor of AIS at discharge, signifying that BASIC best captured the variance in AIS within our study population. Our study provides evidence of convergent validity, construct validity, and clinical predictive validity for the sampled MRI measures of SCI when applied in acute thoracic and thoracolumbar SCI.
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Affiliation(s)
- Marc C. Mabray
- Department of Radiology and Biomedical Imaging, University of California San Francisco and San Francisco General Hospital, San Francisco, California
| | - Jason F. Talbott
- Department of Radiology and Biomedical Imaging, University of California San Francisco and San Francisco General Hospital, San Francisco, California
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - William D. Whetstone
- Department of Emergency Medicine, University of California San Francisco and San Francisco General Hospital, San Francisco, California
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - Sanjay S. Dhall
- Department of Neurological Surgery, University of California San Francisco and San Francisco General Hospital, San Francisco, California
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - David B. Phillips
- Department of Neurological Surgery, University of California San Francisco and San Francisco General Hospital, San Francisco, California
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - Jonathan Z. Pan
- Department of Anesthesia and Perioperative Care, University of California San Francisco and San Francisco General Hospital, San Francisco, California
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - Geoffrey T. Manley
- Department of Neurological Surgery, University of California San Francisco and San Francisco General Hospital, San Francisco, California
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - Jacqueline C. Bresnahan
- Department of Neurological Surgery, University of California San Francisco and San Francisco General Hospital, San Francisco, California
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - Michael S. Beattie
- Department of Neurological Surgery, University of California San Francisco and San Francisco General Hospital, San Francisco, California
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - Jenny Haefeli
- Department of Neurological Surgery, University of California San Francisco and San Francisco General Hospital, San Francisco, California
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - Adam R. Ferguson
- Department of Neurological Surgery, University of California San Francisco and San Francisco General Hospital, San Francisco, California
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
- San Francisco Veteran's Affairs Medical Center, San Francisco, California
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