C5-C6 Level Research Articles

Painful Legs and Moving Toes Syndrome: Case Report and Review

Introduction: Painful legs and moving toes (PLMT) syndrome is a rare movement disorder characterized by defuse lower limb neuropathic pain and spontaneous abnormal, involuntary toe movements. Objective: The objective was to present a rare case of PLMT syndrome with a triggering area in an adult patient due to multilevel discogenic pathology, to make a thorough review of this disorder and to provide a practical approach to its management. Case presentation: A 59-years-old male was admitted to the neurology ward with symptoms of defuse pain in the lower-back and the right leg accompanied by involuntary movements for the right toes intensified by tactile stimulation in the right upper thigh. Magnetic resonance imaging (MRI) revealed a multilevel discogenic pathology of the lumbar and cervical spine, with myelopathy at C5-C7 level. A medication with Pregabalin 300 mg/daily significantly improved both the abnormal toe movements and the leg pain. The clinical effect was constant during the 90-day follow-up without any adverse effects. Conclusion: Painful legs and moving toes (PLMT) is a condition that greatly affects the quality of life of patients, but which still remains less known by clinicians. Spontaneous resolution is rare, and oral medications are the first-line treatment. Pregabalin is a safe and effective treatment option for PLMT that should be considered early for the management of this condition. Other medication interventions, such as botulinum toxin injections, spinal blockade, or non-pharmacological treatment options like spinal cord stimulation, and surgical decompressions, are also recommended when the conservative treatment is ineffective in well-selected patients.

A strong association between Modic changes type 2 and endplate defects at non-fused segments after ACDF

To determine the association between Modic changes (MC) with other MRI parameters and clinical symptoms of cervical degenerative disc disease (DDD). A retrospective analysis of data on patients with cervical DDD who underwent single-level anterior cervical discectomy and fusion. Preoperative demographic data (age, sex, surgical data) were collected, cervical MRI parameters (disc degeneration grade, MC and endplate defects, each determined at each cervical level) and clinical data (Numerical pain rating scale (NPRS) neck and arm, the Neck Disability Index (NDI)) were compared to preoperative data. The study included 121 patients at Visit 1 and 83 patients at Visit 2. The median follow-up duration was 26.5 [18.9; 33.1] months. Patients with MC had more intense NPRS-based neck pain before surgery compared to patients without MC (p=0.001). There were significant changes in MC rate at the C5-C6 levels due to a significant number of new MCs type 1 and MCs type 2 (p=0.002 and p<0.001, respectively). MC type 2 was associated with disc degeneration, endplate defects defects, patients' age and clinical scales (NDI, NPRS) (p<0.05). The endplate defects defect score threshold for predicting MC type 2 at the С3-С7 cervical levels was 5. The factor predicting MC type 2 at the C3-C7 cervical levels is submaximal damage to the endplate. The MC rate is increased due to MC type 1 and MC type 2. MC types at the cervical levels may not represent consecutive stages of the same process.

Combined effect of artificial cervical disc replacement and facet tropism on the index-level facet joints: a finite element study

BackgroundArtificial Cervical Disc Replacement (ACDR) is an effective treatment for cervical degenerative disc diseases. However, clinical information regarding the facet joint alterations after ACDR was limited. Facet tropism is common in the sub-axial cervical spine. Our previous research indicated that facet tropism could lead to increased pressure on the cervical facet joints. This study aimed to assess the impact of facet tropism on the facet contact force and facet capsule stress after ACDR.MethodsA C2–T1 cervical finite element model was constructed from computed tomography (CT) scans of a 28-year-old male volunteer. Symmetrical, moderate asymmetrical (7 degrees tropism), and severe asymmetrical (14 degrees tropism) models were created at the C5/C6 level by altering the facet orientation at the C5-C6 level. The C5/C6 ACDR was simulated in the intact, moderate asymmetrical and severe asymmetrical models. A 75-N follower load with 1.0-Nm moments was applied to the top of C2 vertebra in the models to simulate flexion, extension, lateral bending, and axial rotation with the T1 vertebra fixed. The range of motions (ROMs) under all moments, facet contact forces (FCFs) and facet capsule strains were tested.ResultsIn the asymmetrical model, the right FCFs considerably increased under flexion, extension, right bending, left rotation, especially under right bending the right sided FCF of the severe asymmetrical model was about 5.44 times of the neutral position, and 3.14 times of the symmetrical model. and concentrated on the cephalad part of the facets. The facet capsule stresses on both sides remarkably increased under extension, lateral bending and right rotation. In the moderate and severe asymmetrical models, the capsule strain was greater on both sides of each position than in the symmetric model.ConclusionsThe face tropism increased facet contact force and facet capsule strain after ACDR, especially under extension, lateral bending, and rotation, and also could result in abnormal stress distribution on the facet joint surface and facet joint capsule. The results suggest that face tropism might be a risk factor for post-operative facet joint degeneration progression after ACDR. Facet tropism may be noteworthy when ACDR is considered as a surgical option.

Neck triangle nerve enlargement in hereditary transthyretin amyloidosis correlates with changes in the autonomic, cardiac, and gastrointestinal systems.

Hereditary transthyretin amyloidosis (ATTRv) is a hereditary disease that affects multiple bodily systems. Although sonography generally reveals enlargement of nerves in the limbs, the brachial plexus, and vagus nerve, the clinical significance of these findings remains unclear. We performed sonographic measurements of the median nerve, cervical spinal nerves at the C5-C7 level, and the vagus nerve in patients with ATTRv and healthy controls. Clinical profiles and cardiac and gastrointestinal examination results were also collected for linear regression analysis. We recruited 47 patients with ATTRv (males/females: 34/13, age: 65.6±5.3 years). The sampled segments were all significantly larger than those of the controls. In the clinical profiles, the sum of the Z scores of the neck triangle nerves (cervical spinal nerves and vagus nerve) and of all nerves (cervical spinal nerves, vagus nerve, and median nerve at the wrist) significantly correlated with the familial amyloid polyneuropathy stage, onset of autonomic nervous system (ANS) symptoms, and autonomic symptom scores. On cardiac examinations, several ultrasonography and magnetic resonance imaging parameters (primarily those that reflect heart volume) were found to be significantly correlated with the sum of the Z scores of the cervical spinal nerves but not with the Z score of the vagus nerve. In gastrointestinal evaluation, the cross-sectional area of the vagus nerve was correlated with gastric emptying time parameters on scintigraphy. Neck triangle nerve enlargement on sonography correlated with parameters related to ANS dysfunction, indicating that nerve enlargement observed on ultrasonography may serve as a potential surrogate biomarker of ATTRv.

Effects of Combined Respiratory Physiotherapy with High-Flow Nasal Cannula and Venturi Mask in Spinal Cord Injury: A Single-Subject Research Study and Literature Review.

The level of spinal cord injury affects the severity of respiratory impairment and the alteration of respiratory pattern and gas exchanges. Lesions at the C3-C5 level (phrenic nerve nucleus) cause disruption of descending input with paralysis of the main inspiratory muscle, often requiring tracheostomy and prolonged mechanical ventilation. Oxygen therapy is essential to switch from ventilatory support to removal of the endotracheal tube to correct residual difficulties in oxygenation management. A 58-year-old man had tracheostomy and tetraparesis as complication of tonsillectomy and adenoidectomy treatment for a history of obstructive sleep apnea. A respiratory rehabilitation program with protocol of oxygen therapy with high flow cannula alternated with a low-flow system by Venturi mask during daytime hours only was started. The patient was constantly monitored with capillary partial oxygen saturation to obtain adequate oxygenation (≥ 94%) and registered every 15 minutes in the clinical chart. There was gradual improvement of respiratory function. Oxygen by Venturi mask was gradually reduced due to improvement of partial pressure oxygen values. Over the course of days, the optimal results of respiratory parameters led to a gradual weaning from the Venturi mask until the complete discontinuation of the low-flow system during daytime and decreased of the high-flow fraction of inspired oxygen to the maximal tolerated level during nighttime. Implementing a combined protocol of nighttime oxygen with high flow cannula and daytime Venturi mask improves intensive motor training of patients by promoting the acquisition of ability to perform chair/bed transitions and to be able to achieve standing and begin gait training. More research is needed whether or noted to determine the role of this promising approach in patients with severe SCI and in other critically ill patients. This is a presentation of a new respiratory training protocol of combined oxygen therapy by high flow cannula and Venturi mask in a patient with cervical spinal cord injury and respiratory failure.Due to this new respiratory training, from the weaning of ventilation devices the patient had greater independence and improved quality of life, with more intensive motor training in the gym, improvement of the motor program and the patient tolerance to training.Oxygen therapy with high flow cannula and Venturi mask could be valid and reliable combined respiratory training to improve the respiratory pattern in severely hypoxemic and hypercapnic patients, without adverse events.

Percutaneous and open anterolateral cordotomy for intractable cancer pain: a technical note

IntroductionAnterolateral cordotomy (AL-C) is a long-established treatment for alleviating intractable cancer pain. However, AL-C has progressively fallen into desuetude, leading to the risk of a definitive loss of expertise within neurosurgical teams. Our objective was therefore to provide an update on percutaneous and open AL-C, with special emphasis on contemporary operative technique. Material and methodsPatient selection, indications, outcomes and up-to-date operative technique are reviewed through illustrative cases, including intraoperative photographs and video. ResultsMain indications are represented by unilateral, nociceptive pain refractory to best pharmacological treatment in patients with limited life expectancy. Percutaneous AL-C is performed under cooperative sedation at C1-C2 level. CT myelography guidance and intraoperative electrophysiology allow accurate targeting of the spinothalamic tract (STT). Thermocoagulation is performed at 80 °C for 60 s during a Mingazzini maneuver, in order to promptly detect the potential onset of a motor weakness. Open AL-C is performed under general anesthesia at T2-T3 level. The dentate ligament is suspended to gently rotate the spinal cord and expose the anterolateral column. Section of the STT is made with a micro scalpel blade at a depth of 4−5 mm, from the dentate ligament to the emergence of ventral rootlets. Success rate after AL-C is high and allows a marked reduction in antalgic drugs intake. Main limitations include failure in achieving long-standing pain relief and the new occurrence of spontaneous, mirror pain. ConclusionAL-C is a safe and effective option for the management of opioid-resistant cancer pain, which should be part of the neurosurgeon’s armamentarium.

Duropathy as a rare motor neuron disease mimic: from bibrachial amyotrophy to infratentorial superficial siderosis

BackgroundBibrachial amyotrophy associated with an extradural CSF collection and infratentorial superficial siderosis (SS) are rare conditions that may occasionally mimic ALS. Both disorders are assumed to be due to dural tears.Case presentationA 53-year-old man presented with a 7-year history of slowly progressive asymmetric bibrachial amyotrophy. Initially, a diagnosis of atypical motor neuron disease (MND) was made. At re-evaluation 11 years later, upper limb wasting and weakness had further progressed and were accompanied by sensorineural hearing loss. MRI of the brain and spine demonstrated extensive supra- and infratentorial SS (including the surface of the whole spinal cord) as well as a ventral longitudinal intraspinal fluid collection (VLISFC) extending along almost the entire thoracic spine. Osteodegenerative changes were observed at C5-C7 level, with osteophytes protruding posteriorly. The bony spurs at C6-C7 level were hypothesized to have lesioned the dura, causing a CSF leak and thus a VLISFC. Review of the MRI acquired at first evaluation showed that the VLISFC was already present at that time (actually beginning at C7 level), whereas the SS was not. 19 years after the onset of upper limb weakness, the patient additionally developed parkinsonism. Response to levodopa, brain scintigraphy with 123I-ioflupane and brain MRI with nigrosome 1 evaluation were consistent with idiopathic Parkinson’s disease (PD). On the latest follow-up 21 years after symptom onset, the VLISFC was unchanged, as were upper arm weakness and wasting.ConclusionsBased on the long-term follow-up, we could establish that, while the evidence of the VLISFC was concomitant with the clinical presentation of upper limb amyotrophy and weakness, the radiological signs of SS appeared later. This suggests that SS was not per se the cause of the ALS-like clinical picture, but rather a long-term sequela of a dural leak. The latter was instead the causative lesion, giving rise to a VLISFC which compressed the cervical motor roots. Dural tears can actually cause several symptoms, and further studies are needed to elucidate the pathophysiological correlates of “duropathies”. Finally, as iron metabolism has been implicated in PD, the co-occurrence of PD with SS deserves further investigation.

Acylcarnitines metabolism in depression: association with diagnostic status, depression severity and symptom profile in the NESDA cohort.

Acylcarnitines (ACs) are involved in bioenergetics processes that may play a role in the pathophysiology of depression. Previous genomic evidence identified four ACs potentially linked to depression risk. We carried forward these ACs and tested the association of their circulating levels with Major Depressive Disorder (MDD) diagnosis, overall depression severity and specific symptom profiles. The sample from the Netherlands Study of Depression and Anxiety included participants with current (n = 1035) or remitted (n = 739) MDD and healthy controls (n = 800). Plasma levels of four ACs (short-chain: acetylcarnitine C2 and propionylcarnitine C3; medium-chain: octanoylcarnitine C8 and decanoylcarnitine C10) were measured. Overall depression severity as well as atypical/energy-related (AES), anhedonic and melancholic symptom profiles were derived from the Inventory of Depressive Symptomatology. As compared to healthy controls, subjects with current or remitted MDD presented similarly lower mean C2 levels (Cohen's d = 0.2, p ≤ 1e-4). Higher overall depression severity was significantly associated with higher C3 levels (ß=0.06, SE = 0.02, p = 1.21e-3). No associations were found for C8 and C10. Focusing on symptom profiles, only higher AES scores were linked to lower C2 (ß=-0.05, SE = 0.02, p = 1.85e-2) and higher C3 (ß=0.08, SE = 0.02, p = 3.41e-5) levels. Results were confirmed in analyses pooling data with an additional internal replication sample from the same subjects measured at 6-year follow-up (totaling 4141 observations). Small alterations in levels of short-chain acylcarnitine levels were related to the presence and severity of depression, especially for symptoms reflecting altered energy homeostasis. Cellular metabolic dysfunctions may represent a key pathway in depression pathophysiology potentially accessible through AC metabolism.

AIRWAY CHALLENGES IN A ANKYLOSING SPONDYLITIC PATIENT WITHTRAUMATIC CERVICAL SPINE FRACTURE - A CASE REPORT

Background:Ankylosing Spondylitis (AS) is a chronic inflammatory condition that results in the fusion of the spine and decreased flexibility, commonly known as bamboo spine. This condition presents significant challenges to anesthesiologists due to potential difficulties in managing the airway, cardiovascular issues, and compromised respiration. AS patients face an increased risk of fractures and spinal cord injury, especially in the cervical spine, which is prone to instability and higher morbidity and mortality rates. Maneuvers to manage the airway and intubation techniques may exacerbate movement in the cervical spine, potentially leading to further injury. Case Report: A 42-year-old man with a history of AS presented with a cervical spine injury after a road traffic accident. MRI showed fractures at the posterior arch of C1 and C4-C5 levels with nerve root compression. The patient, who was not regularly followed up, was taking medication. Preoperative assessment revealed a potentially difficult airway, and the patient had quadriparesis and reduced sensation. Due to the risk of spinal cord injury, an awake fiberoptic intubation (AFOI) was planned. The AFOI was successfully performed through the nasal route, and the patient underwent a C4-C5 discectomy and stabilization. The postoperative recovery was uneventful, with no new neurological deficits. Discussion: The case emphasizes the need to minimize movement of the cervical spine when managing the airway in AS patients with cervical spine fractures. Using AFOI is more effective than other techniques in this scenario, as it minimizes cervical movement and allows for post-intubation neurologic assessments. Although the glidescope video laryngoscope and intubating laryngeal mask airway are considered as alternatives to direct laryngoscopy, anesthesiologists still prefer AFOI as the primary option. Conclusion: This case report demonstrates the best airway management for an AS patient with a cervical spine fracture, with a focus on the role of the anesthesiologist in preventing further injury and neurologic deterioration. Awake fiberoptic intubation is the safest alternative for AS patients with cervical spine fractures, as long as the anesthesiologist has the requisite skills and knowledge.

Blunt Traumatic Vertebral Artery Injury After Cervical Fracture Dislocation: A Systematic Review of the Literature.

Certain high-energy blunt forces may produce unstable cervical fractures with or without dislocation. In rare cases where the superior facets are dislocated, however showing a significant increase within the last decade, these types of injuries may include vertebral artery entrapment at the involvement level leading to artery dissection or occlusion. This phenomenon is usually seen at the C4-C5 and C5-C6 levels of injury. A systematic review of the literature was performed by examining online databases such as PubMed - NCBI, Web of Science, Cochrane Library, Scopus, and Embase to identify relevant scientific articles. Keywords (MeSH terms) used in the search included cervical spine injuries, cervical spine dislocation, cerebrovascular injury, vertebral artery injury, vertebral artery injury management, and incidence of vertebral artery injury. Initially, 1516 studies were identified as a primary search for screening. After excluding papers that did not fulfill the inclusion criteria, 34 studies were included in this review. Vertebral artery injury consists of a severe complication that could compromise a surgical intervention since the patient's clinical image may be unrevealing at first. Early diagnosis and correct timing constitute the golden standard for adequate treatment. This systematic review aims to summarize the current evidence for the diagnosis, management, and treatment of blunt traumatic vertebral artery injuries.

How Static and Cyclic Loading Affect the Mechanical Properties of the Porcine Annulus Fibrosus.

This study sought to evaluate the effects of prolonged cyclic loading on the tissue-level mechanical properties of the spinal annulus fibrosus. Functional spinal units (FSUs) were obtained from porcine cervical spines at the C3-C4 and C5-C6 levels. Following a 15-min preload of 300 N of axial compression, the FSUs were split into three groups: the cyclic loading group cycled between 0.35 MPa and 0.95 MPa for 2 h (n = 8); the static loading group was compressed at 0.65 MPa for 2 h (n = 10); and a control group which only underwent the 300 N preload (n = 11). Following loading, samples of the annulus were excised to perform intralamellar tensile testing and interlamellar 180 deg peel tests. Variables analyzed from the intralamellar test were stress and strain at the end of the toe region, stress and strain at initial failure (yield point), Young's modulus, ultimate stress, and strain at ultimate stress. Variables evaluated from the interlamellar tests were lamellar adhesion strength, adhesion strength variability, and stiffness. The analysis showed no significant differences between conditions on any measured variable; however, there was a trend (p = 0.059) that cyclically loaded tissues had increased adhesion strength variability compared to the static and control conditions. The main finding of this study is that long-duration axial loading did not impact the intra- or interlamellar mechanical properties of the porcine annulus. A trend of increased adhesion strength variability in cyclically loaded samples could indicate a potential predisposition of the annulus to delamination.

Role of serum complement C3 and C4 on kidney outcomes in IgA nephropathy

IgA Nephropathy (IgAN) is the most prevalent glomerular disease worldwide. Complement system activation is crucial in its pathogenesis. Few studies correlated serum C3 and C4 with disease activity and prognosis. This retrospective study investigated the prognostic value of serum complement at the time of diagnosis in patients with IgAN. Specifically we evaluated whether adding serum C3 and C4 levels to established predictive models-one based on variables related to chronic kidney disease (CKD) progression and another incorporating variables from the International IgA Prediction Tool (IntIgAPT)-enhances the accuracy of outcome prediction. A composite renal outcome was defined as 50% decline in eGFR or onset of kidney failure. 101 patients were stratified according to baseline C3 levels in three groups (Low, Medium and High). During a median follow-up of 54 months, the Low group exhibited higher incidence of primary outcome (16.3 events vs 2.9 and 1.7 events × 100 pts/year, p = 0.0026). Model-1 (M1), consisting of CKD progression variables, and Model-3 (M3), comprising IntIgANPT variables, were implemented with baseline C3 and C4 to create Model-2 (M2) and Model-4 (M4), respectively. M2 demonstrated better predictive performance over M1, showing higher discrimination (lower AIC and BIC, higher C-index and NR2). Similarly, M4 outperformed M3, showing enhanced outcome prediction when C3 and C4 levels were added. Implementation of serum C3 and C4 can enhance prediction accuracy of already-validated prognostic models in IgAN. Lower C3 and higher C4 levels were associated with poorer prognosis, highlighting a more 'Complement-Pathic' subset of patients.

Biomechanical Motion Changes in Adjacent and Noncontiguous Segments Following Single-Level Anterior Cervical Discectomy and Fusion: A Computed Tomography-Based 3D Motion Capture Study.

Anterior cervical discectomy and fusion (ACDF) is known to elicit adverse biomechanical effects on immediately adjacent segments; however, its impact on the kinematics of the remaining nonadjacent cervical levels has not been understood. This study aimed to explore the biomechanical impact of ACDF on kinematics beyond the immediate fusion site. We hypothesized that compensatory motion following single-level ACDF is not predictably distributed to adjacent segments due to compensation from noncontiguous levels. Six fresh-frozen cervical spines (C2-T1) underwent fluoroscopic screening and sagittal and coronal reformats from computed tomography scans and were utilized to grade segmental degeneration. Each specimen was tested to 30° of flexion and extension intact and following single-level ACDF at the C5-C6 level. The motions of each vertebral body were tracked using 3-dimensional (3D) motion capture into an inverse kinematics model, facilitating correlations between the 3D reconstruction from computed tomography images and the 3D motion capture data. This model was used to calculate each level's flexion/extension range of motion (ROM). Single-level fusion at the C5-C6 level across all specimens resulted in a significant motion reduction of -6.8° (P = 0.002). No significant change in ROM occurred in the immediate adjacent segments C4-C5 (P = 0.07) or C6-C7 (P = 0.15). Hypermobility was observed in 2 specimens (33%) exclusively in adjacent segments. In contrast, the other 4 spines (66%) displayed hypermobility at noncontiguous segments. Hypermobility occurred in 42% (5/12) of the adjacent segments, 28% (5/18) of the noncontiguous segments, and 50% (3/6) of the cervicothoracic segments. Single-level ACDF impacts ROM beyond adjacent segments, extending to noncontiguous levels. Compensatory motion, not limited to adjacent levels, may be influenced by degenerative changes in noncontiguous segments. Surprisingly, hypermobility may not occur in adjacent segments after ACDF. Overall, the multifaceted biomechanical effects of ACDF underscore the need for a comprehensive understanding of cervical spine dynamics beyond immediate adjacency, and it needs to be taken into consideration when planning single-level ACDF.

Bilateral Vocal Fold Motion Impairment Associated With Diffuse Idiopathic Skeletal Hyperostosis.

To describe the clinical courses and interventions of symptomatic patients with bilateral vocal fold motion impairment (BVFMI) attributed to diffuse idiopathic skeletal hyperostosis (DISH). Retrospective cohort study. Single Institution Academic Health Center. Retrospective chart review of patients ≥18 years old evaluated and treated for symptomatic BVFMI secondary to DISH between February 2021 and March 2023. A literature review was conducted. A total of 4 cases were identified. All patients were male and had symptomatic BVFMI attributed to cervical spine DISH, as seen on imaging. Symptoms ranged from life-threatening dyspnea to breathy dysphonia in addition to dysphagia. Each patient was offered surgery for DISH. Two patients underwent osteophyte removal at the C5-C6 level with improved vocal fold (VF) mobility, breathing, and voice quality. Two patients elected serial observation as voice, swallow, and airway symptoms were manageable. The literature review showed a male-dominant (100%) presentation with an average of 70 years of age. Hypertension (45%) and diabetes mellitus (36%) were the most common comorbidities. Most patients were treated surgically (55%). Both surgical and conservative interventions may be considered for symptomatic relief and improvement in VF mobility on a patient-to-patient basis. Further study is warranted to investigate the etiology and treatment outcomes in these cases.

Different aspects of immunological profile in patients with Non-Alcoholic Fatty liver disease.

NAFLD is thought to affect approximately one-fourth of the world's population. Therefore, we evaluated the role of serum complement and immunoglobulins in the NAFLD pathogenesis. 200 participants were used in this study, divided into two groups; Group I: 100 NAFLD patients and Group II: 100 healthy volunteers. The diagnosis of NAFLD is based on non-invasive methods, following the EASL guideline 2022. IgG, IgM, IgA, C3, and C4 assays were performed on all participants. When the immunological profiles of patients with NAFLD and healthy controls were compared, it was found that the mean IgA in NAFLD patients was (4.20±5.07), whereas the mean IgA in healthy controls was (2.22±1.05) (P=0.000). Additionally, a significant increase in IgG was found in NAFLD patients (17.08±3.87) compared with healthy controls (11.59±3.34), with a P value of (p<0.001). complement C3 and complement C4 levels significantly increased in nonalcoholic fatty liver disease patients (1.28± 0.61 and 0.40 ± 0.19, respectively), compared to healthy controls (0.90 ±0.27 and 0.30 ±0.12, respectively), with a significant P value (p<0.001 for each). Elevated IgA, IgG, C3 and C4 exist in patients with NAFLD and could be associated with fatty liver development and progression of hepatic fibrosis in patients with NAFLD.

Trauma of the spine: Epidemiological aspects and tomodensitometric in Niamey

Introduction: The trauma of spine is a frequent pathology. It is a pathology of young male adults. Medical imaging in particular CT scan is essential in the precise assessment of traumatic bone lesions of the spine. Aim: Study the epidemiological and computed tomography aspects of spine trauma in radiology and medical imaging services at the Niamey National Hospital and the Niamey Reference General Hospital. Materials and methods: This is a retrospective and prospective study about 73 cases collected at Niamey National Hospital and Niamey Reference General Hospital from January 1, 2016 to October 31, 2019. Results: In this study, male sex was largely predominant. The age group 20-30 was the most represented. The cervical and back spinal floors were the most explored. The fracture was the most found lesion. The compact fracture is the most recorded fracture in the vertebral body. The cervical spine was the seat of the majority of fractures. The anterior luxation was notified, and like the fracture, it was mainly located at the level of the cervical spine more precisely at the level of C5-C6. The post-traumatic disc hernia was mainly cervical and the location was majority C5-C6. Note the spinal channel was mostly normal. Conclusion: The trauma of the spine is a frequent pathology which most often affects young male adults. Computed tomography allows a balance of traumatic bone lesions of the spine.

Surgical management of cervical intramedullary cavernoma: case report and systematic review of the literature

BackgroundCavernous malformations can occur throughout the cerebral nervous system, most commonly located in the supratentorial compartment. The intramedullary location is rare and accounts for approximately 2.4% to 5% of all spinal vascular tumors. The cervical cord location and its clinical manifestations are underreported.MethodsThe authors report a case of spinal cord compression at the C5–C6 level by a cervical intramedullary cavernoma with a systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and meta-analysis guidelines. Relevant studies (1980 to 2023) that reported patients with cervical intramedullary cavernoma were identified from PubMed databases.ResultsA total of 29 studies reporting 423 patients were included in this study with a mean age of 40.5 ± 6.3 years old. The overall male-to-female ratio was 1:2.5 with a median duration of follow-up of 46 months [18.5–63.9]. The type of resection as well as the patient’s outcome was also reported.ConclusionIntramedullary cavernous angiomas are rare. Early surgical total resection of the symptomatic lesions in adequate conditions is crucial for good outcomes.

#1486 Looking for a new role of known players: the additional value of plasmatic C3 and C4 in predicting IgA Nephropathy prognosis, an observational study

Abstract Background and Aims IgA Nephropathy (IgAN) is the most common glomerular disease worldwide [1]. Complement system activation through the alternative and lectin pathways is crucial in its pathogenesis and leads to worse outcome, eliciting the need for (new) biomarkers to assess risk of disease progression and potential response to new targeted treatments [2, 3]. Only few works have correlated serum C3 and C4 with disease activity and prognosis [4, 5]. Our work explores the potential advantages of incorporating serum C3 and C4 levels into a standardized prognostic model to assess kidney outcome in IgAN. Method This retrospective study, conducted at Sant'Orsola University Hospital in Bologna, investigated the prognostic value of serum complement C3 and C4 in patients with IgAN. The primary outcome was defined as a 40% decline in eGFR or the onset of kidney failure. The study aimed to evaluate whether the addition of serum C3 and C4 to an established predictive model, incorporating variables from the International IgA Prediction Tool (IntIgAPT), enhances the accuracy of outcome prediction. We computed the measures of goodness of fit for each model: Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC), Nagelkerke R2 test (NR2) that depicts the% explained variation of the outcome based on the set of variables included, and Likelihood Ratio Test (LRT); discrimination with the c-index. Furthermore, we aimed to evaluate the characteristics of patients stratified by baseline serum C3 levels (Low &amp;lt;90 mg/dl, Medium 90-140 mg/dl, High &amp;gt;140 mg/dl). Results 101 patients were included in the cohort. 90% were Caucasian and 65.3% were male with a mean age of 42.6 years. As reported in Table 1, mean eGFR and median proteinuria levels at baseline were 70.4 ml/min/1.73 m² and 1.04 g/24 h respectively. Mean serum C3 was 114.9 mg/dL. The Low group had lower values of eGFR at baseline (47.0 vs 75.67 and 68.64 ml/min/1.73 m², p = 0.015), while the Medium group had lower values of uProt (0.75 vs 1.81 and 1.46 g/24 h, p = 0.004). During a median 54.28 months follow-up, the Low group exhibited significantly higher primary outcome incidence (16.3 events vs 2.9 and 1.7 events x 100 pts/year, p = 0.003). We computed a first model (M1) based upon IntIgAPT variables and then a second model (M2) as the same of M1 plus serum C3 and C4 at baseline (Table 2). C3 showed a negative association with outcome (OR 0.88, CI 0.78 to 0.99, p = 0.05) whereas C4 had a positive one (OR 1.21, CI 1.02 to 1.48, p = 0.05). M2 had an improved prediction accuracy than M1, as evidenced by lower AIC (49.1 vs 53.8), higher c-index (0.74 vs 0.65), and NR2 (0.76 vs 0.65). Likelihood ratio test was significant between the two (p = 0.008). Conclusion The inclusion of serum C3 and C4 in a validated prognostic model enhances prediction accuracy and improves the percentage of events explained, highlighting complement's inherent informativeness. In our population lower C3 and higher C4 levels were associated with poorer prognosis in IgAN, characterizing a more ‘Complement-Pathic’ subset of patients. This result expands the current evidence, for the first time to our knowledge, in a Caucasian-prevalent study population.

Strain of the vertebral artery during passive neck movements and spinal manipulation of the cervical spine: An observational study

BackgroundNeck pain is a common condition, and a frequent treatment is chiropractic cervical spinal manipulation therapy (cSMT). However, cervical spinal manipulations have been associated with excessive cervical artery elongations, allegedly causing arterial dissection leading to stroke. PurposeThe primary purpose of this study was to quantify the total vertebral artery elongations during cSMT, and secondarily, quantify the vertebral artery elongations during the pre-manipulative orientation of the head and neck and the subsequent elongations during the actual thrust. MethodsVertebral artery strains were measured at the cervical levels C0–C1, C1–C2, and C2–C3 using piezoelectric crystals that were sutured to the wall of the left and right vertebral artery in three cadavers. Vertebral artery strains were measured continuously for a full set of passive range of motion testing and for the chiropractic spinal manipulation. FindingsFor the range of motion testing, the greatest average vertebral artery strains at the C0–C1 level were 6.9% for ipsilateral flexion-rotation, at the C1–C2 level 4.3% for contralateral rotation, and at the C2–C3 level 3.7% for contralateral flexion-rotation. For the chiropractic spinal manipulation, the average maximal strains at the C0–C1, C1–C2 and C2–C3 levels were 1.3%, 0.1%, and 1.0%, respectively. The maximal average vertebral artery strains in the pre-manipulative phase were 0.5% and the corresponding maximal vertebral artery strains during the manipulative thrust was 1.1%. InterpretationPassive range of motion testing produced strains in the vertebral artery were 5.3 times (C0–C1), 7.2 times (C1–C2), and 3.7 times (C2–C3) greater than the corresponding strains during chiropractic spinal manipulation, suggesting that strains in the vertebral artery during chiropractic spinal manipulation were much smaller than the strains that can occur during normal everyday movements of the head and neck. Furthermore, vertebral artery strains in the pre-manipulative phase did not contribute to the peak strains on the contralateral vertebral artery and helped reduce strains on the ipsilateral side.

Biomechanical Analysis of Trapezoidal Thread Screw-Rod Fixation in Pedicle Section of Cervical Spine: A Finite-Element Analysis.

Cervical pedicle screw-rod fixation presents a complex approach in spinal surgery, offering enhanced spine stabilization in variable conditions considering traumatic injuries, degenerative changes, as well as orthopaedic and oncological ailments. This technique employs small diameter screw implants strategically placed to bolster the mechanical integrity of the spine. Notably, it involves minimally invasive procedures, resulting in smaller incisions and reduced patient discomfort. This study aims to assess the effects of trapezoidal thread screws in pedicle sections of the cervical spine during flexion-extension loadings, focusing on factors such as range of motion (ROM), implant stress, and stress on adjacent bone. Utilizing CT scan data, a finite element model of the cervical spine (C2-C7 vertebrae) was prepared. Trapezoidal thread screws were integrated into a single-level pedicle screw-rod fixation at the C5-C6 vertebrae. The C2 vertebra were given a compressive load of 50 N along with a moment of 1 Nm, resulting in the immobilization of the C7. The results indicate a reduction in ROM at the C5-C6 level by 69% to 77% compared to the intact spine during flexion-extension loading, with a slight increase in ROM observed at adjacent cervical spine levels. Stress analysis revealed that the trapezoidal thread screws induced stresses ranging from 24 MPa to 29 MPa in PEEK trapezoidal screw-rod implants, which fall below the material's yield stress. This suggests that the trapezoidal thread profile may be advantageous in minimizing stress concentration, attributed to its larger contact area with the vertebrae bone between the threads.