Cervical Level Research Articles

Effects of cervical transcutaneous spinal direct current stimulation on spinal excitability

ObjectiveTo investigate the effects of transcutaneous spinal direct current stimulation (tsDCS) on spinal cord excitability using neurophysiological methods. MethodsSpinal cord motoneuron excitability was assessed using various neurophysiological techniques in a sham-controlled randomized experiment, which involved delivering 2 mA tsDCS and testing four different montages. Transcranial magnetic stimulation (TMS), F-waves to supramaximal ulnar nerve stimulation and somatosensory evoked potentials to upper limb nerves stimulation were measured in the participants with the electrode configuration that yielded the greatest effect, for a total of about 18 min. 18 young volunteers were recruited. ResultsAmong the tested ones, the most promising tsDCS montage was the one with the anode placed on the 7th cervical spinous process and the cathode on the glottis. With this configuration, a significant enhancement of motor responses in the hand muscles to TMS of the contralateral hand motor area was observed during tsDCS (p<0.00001), reaching a plateau after 6 min. This facilitation rapidly declined within a few minutes after the tsDCS was stopped. ConclusionResults of the different techniques suggest a possible contribution to facilitatory neuromodulation of the motoneurons at the cervical spine level. SignificanceThe occurrence of enhanced excitability after tsDCS suggests potential application in individuals with partial corticospinal fiber impairment affecting hand motor function.

Cadaveric study of the ultrasound-guided inter-transversospinalis plane block in dogs for the cervical epaxial musculature region.

Blockage of the dorsal rami of the spinal nerves (DRSN) provides analgesia to the epaxial musculature area in dogs. However, techniques to block the DRSN at the cervical level in dogs haven't yet been investigated. This study aimed to study the anatomy of the cervical area, and to describe a new ultrasound (US)-guided inter-transversospinalis plane (ITP) block technique at the 5th cervical vertebrae (C5). Fourteen adult canine's cadavers were used in this blinded, cadaveric, experimental study. One cadaver for cryo-section, one for anatomical research and twelve to do an ITP injection using 0.3 mL/kg (HV) or 0.15 mL/kg (LV) of dye/contrast solution in each lateral at C5, followed by a computed tomography and anatomical dissection.The HV and LV groups stained a median (range) of 4.67 (3-6) and 3.67 (2-5) DRSN into the ITP, respectively (P<0.017). Stained DRSN in the splenius plane were found in nine (75%) HV and five (41.66%) LV injections, respectively. Spread in the epidural space was found in two dogs using LV. One of them was injected into the ITP (4.33 %) while the other one was done accidentally outside of this plane. The paravertebral spread was found in one injection of each group. There was no dye of the ventral rami of the spinal nerves. The US-guided ITP injection is feasible in dog cadavers. The LV injected just after the medial surface of the semispinalis capitis muscle is recommended to avoid a possible extensive epidural spread.

Changes in intra- and interlimb reflexes from forelimb cutaneous afferents after staggered thoracic lateral hemisections during locomotion in cats.

In quadrupeds, such as cats, cutaneous afferents from the forepaw dorsum signal external perturbations and send inputs to spinal circuits to co-ordinate the activity in muscles of all four limbs. How these cutaneous reflex pathways from forelimb afferents are reorganized after an incomplete spinal cord injury is not clear. Using a staggered thoracic lateral hemisections paradigm, we investigated changes in intralimb and interlimb reflex pathways by electrically stimulating the left and right superficial radial nerves in seven adult cats and recording reflex responses in five forelimb and ten hindlimb muscles. After the first (right T5-T6) and second (left T10-T11) hemisections, forelimb-hindlimb co-ordination was altered and weakened. After the second hemisection, cats required balance assistance to perform quadrupedal locomotion. Short-, mid- and long-latency homonymous and crossed reflex responses in forelimb muscles and their phase modulation remained largely unaffected after staggered hemisections. The occurrence of homolateral and diagonal mid- and long-latency responses in hindlimb muscles evoked with left and right superficial radial nerve stimulation was significantly reduced at the first time point after the first hemisection, but partially recovered at the second time point with left superficial radial nerve stimulation. These responses were lost or reduced after the second hemisection. When present, all reflex responses, including homolateral and diagonal, maintained their phase-dependent modulation. Therefore, our results show a considerable loss in cutaneous reflex transmission from cervical to lumbar levels after incomplete spinal cord injury, albeit with preservation of phase modulation, probably affecting functional responses to external perturbations. KEY POINTS: Cutaneous afferent inputs co-ordinate muscle activity in the four limbs during locomotion when the forepaw dorsum contacts an obstacle. Thoracic spinal cord injury disrupts communication between spinal locomotor centres located at cervical and lumbar levels, impairing balance and limb co-ordination. We investigated cutaneous reflexes from forelimb afferents during quadrupedal locomotion by electrically stimulating the superficial radial nerve bilaterally, before and after staggered lateral thoracic hemisections in cats. We showed a loss/reduction of mid- and long-latency homolateral and diagonal reflex responses in hindlimb muscles early after the first hemisection that partially recovered with left superficial radial nerve stimulation, before being reduced after the second hemisection. Targeting cutaneous reflex pathways from forelimb afferents projecting to the four limbs could help develop therapeutic approaches aimed at restoring transmission in ascending and descending spinal pathways.

Morphophysiological Assessment of the Cervix during the Reproductive Cycle and Early Pregnancy in Does Using Computed Tomography and Oxytocin Receptor Immunohistochemistry.

This study aimed to elucidate the morphophysiology and oxytocin receptor (OXTR) expression in the cervix of doe goats during various reproductive stages to enhance reproductive management strategies. A total of 40 cervical samples were categorized into follicular (n = 15), luteal (n = 10), and early pregnancy (n = 15) stages. Utilizing advanced imaging based on functional and morphological markers, the study employed computed tomography (CT) scans, histochemical staining (Masson trichrome and alcian blue), immunohistochemistry, Western blotting, and quantitative PCR (qPCR) to assess structural changes in the cervix and in OXTR expression during the estrous cycle and early pregnancy. CT scans revealed consistent cervical folds and a significant reduction in cervical width during pregnancy, suggesting structural adaptations for gestational integrity. Histochemical analyses indicated a well-organized collagen network and presence of mucins, essential for cervical function and integrity. Immunohistochemistry and Western blotting demonstrated elevated OXTR protein levels during the follicular stage, which were markedly reduced during pregnancy, indicating a role in facilitating cervical relaxation and sperm transport during estrus and maintaining cervical closure during gestation. qPCR analysis showed stable OXTR mRNA levels during follicular and luteal stages with a slight, non-significant increase during pregnancy, pointing towards posttranscriptional regulatory mechanisms. In conclusion, this study demonstrates that cervical morphology and OXTR expression in doe goats undergo significant changes across reproductive stages, with elevated OXTR protein levels during the follicular phase and notable reductions in cervical width and OXTR protein levels during pregnancy, indicating structural and functional adaptations for both reproductive processes and gestational integrity.

Motor improvement and spasms recovery with high-frequency 10kHz spinal cord stimulation in a patient with spastic tetraparesis: beyond pain relief.

To describe the clinical outcomes beyond pain relief of high-frequency spinal cord stimulation at 10kHz (10kHz SCS) in a patient with cervical myelopathy and drug-resistant chronic neuropathic pain with spastic tetraparesis. A patient with C3-C6 myelomalacia and spastic tetraparesis previously treated with decompressive laminectomy underwent implantation of 10kHz SCS for pain management through a trial procedure followed by permanent implantation. Due to the presence of epidural fibrotic scar tissue in the area of the previous C3-C6 laminectomy, the leads could not be implanted at the cervical level; therefore, the leads were positioned at the thoracic level. Data were collected during routine follow-up visits up to 15 months after implantation. Since the trialing phase and during all follow-up visits, along with complete pain relief in the lower limbs, a recovery from spasms was observed with an improvement in motor function. The patient recovered from a sensation of stiffness and difficulty in movement, with a significant decrease in muscle tone, regaining confidence in walking, and no longer needing assistance even for long walking distances. Although all disabling and painful symptomatology in the upper limbs instead did not ameliorate, the Oswestry Disability Index (ODI) score decreased from 50% at baseline to 6%. To our knowledge, recovery from spasms and motor improvement in a spastic tetraparesis patient has never been reported before with 10kHz SCS and possibly this new stimulation paradigm may overcome some performance limitations of traditional low-frequency SCS (LF-SCS). Treatment eliminated spasms at the lower limbs but not at the upper ones, thus suggesting that the location of the epidural leads could affect outcomes.

Surgery on the C3-4 Level and the Presence of Ligamentum Flavum Hypertrophy Increases the Risk of 30-Day Reoperation Rate After Anterior Cervical Discectomy and Fusion

BACKGROUND AND OBJECTIVES: Cervical myelopathy caused by C3-4 level degeneration often exhibits different characteristics after anterior cervical discectomy and fusion (ACDF) than other cervical levels. This study compared the outcomes of C3-4 ACDF with surgeries at other levels and identified risk factors of 30-day reoperation after ACDF. METHODS: We retrospectively analyzed patients who underwent ACDF for degenerative cervical disease from 2018 to 2023. The patients were divided into 2 groups based on the level of surgery: C3-4 and non–C3-4 groups. Radiological outcomes, including cervical alignment and range of motion (ROM), were analyzed. Clinical outcomes were assessed with patient-reported outcomes and the rates of 30-day reoperation and complications after ACDF. Patient-reported outcomes included visual analog scale for neck pain, visual analog scale for arm pain, and modified Japanese Orthopedic Association scores. Risk factors of 30-day reoperation were assessed. RESULTS: Of 259 patients, 74 (28.6%) and 185 (71.4%) were in the C3-4 and non–C3-4 groups, respectively. The C3-4 group exhibited lower C2-7 ROM (P = .019), higher C3-4 ROM (P = .015), and greater C3-4 %ROM (P = .014). The C3-4 group demonstrated lower preoperative and 1-month postoperative modified Japanese Orthopedic Association scores (P &lt; .001; P &lt; .001, respectively). The rate of 30-day reoperation was significantly higher in the C3-4 group (9.5%) compared with the non–C3-4 group (2.2%) (P = .014). In addition, C3-4 surgical level (odds ratio = 4.99, P = .034) and ligament flavum hypertrophy (odds ratio = 5.84, P = .018) were identified as independent risk factors of 30-day reoperation after ACDF. CONCLUSION: Surgery on C3-4 level showed a higher risk of 30-day reoperation than other levels. It is likely due to C3-4 surgical level, and ligament flavum hypertrophy contributes to cord compression, particularly in the unstable early postoperative period.

Cervical Spondylosis Severity and Its Correlation with Clinical Parameters and Cervical Lesions in Multiple Sclerosis: A Cross-Sectional MRI Study

Background: The co-occurrence of multiple sclerosis (MS) and cervical spondylosis (CS) may not only intensify symptoms but also complicate the management of these disorders. Magnetic resonance imaging (MRI) is the preferred modality for detecting spinal cord lesions; however, there is limited evidence assessing myelopathy in concurrent CS and MS. Objectives: This study aims to evaluate the association between CS and its effects on the spinal cord, as well as their impact on enhancing MS cervical lesions. Methods: This cross-sectional study was conducted on 104 MS patients between 2019 and 2021. Data collected included age, gender, duration and phenotype of MS, and the Extended Disability Status Scale (EDSS). Magnetic resonance imaging images were obtained and analyzed for the presence of cervical spondylosis and demyelinated cervical plaques (active/inactive). Multiple sclerosis plaques were evaluated based on their extension, enhancement, and cervical location. Cervical spondylosis was categorized into four grades using the Muhle scale. Additionally, the spinal cord cross-sectional area (SC - CSA) was measured at the C2 - C3 cervical spine level. Results: The severity of cervical spondylosis was associated with older age (P-value &lt; 0.001), longer duration of MS (P-value = 0.04), more severe EDSS scores (P-value = 0.03), and a lower C2 - C3 CS-CSA (P-value &lt; 0.001). However, no significant associations were found with gender (P-value = 0.90), MS plaques activity (P-value = 0.25), or extension (P-value = 0.13). Conclusions: The study findings indicate that the severity of CS is associated with age, MS duration, EDSS, and the C2 - C3 cervical spine cross-sectional area. However, the study did not find evidence supporting a relationship between CS and the extension or activity of MS plaques.

Traumatic spinal cord injury and its correlation to risk of autoimmune/-inflammatory disease.

Nationwide epidemiological open cohort study. To evaluate whether individuals with traumatic spinal cord injury (TSCI) are more prone to develop autoimmune diseases compared to a general non-TSCI population. Danish public national registries. An open nationwide cohort, including individuals born in Denmark from or alive during 1945-2018 was collected and the study period was 1980-2018. Poissons Log-linear regression estimated the incidence rate ratio (IRR) for developing eight groups of autoimmune diseases. A dose-response relationship based on the cervical/thoracic level of injury was assessed by stratification. The cohort included 3,272 individuals with TSCI and 4.8 million background individuals, accounting for 50,865 and 140 million person-years respectively. The TSCI population had an overall IRR of 1.81 (95% CI, 1.59 to 2.05) of getting any autoimmune disease. Subgroup analysis found positive associations for; a) Other neurologic IRR 5.19 (95% CI, 2.79 to 9.65), b) multiple sclerosis IRR 3.70 (95% CI, 2.54 to 5.40), c) Dermatologic IRR 2.57 (95% CI, 1.86 to 3.55), d) Type 1 diabetes mellitus IRR 2.01 (95% CI, 1.54 to 2.61), e) Systemic 1.92 (95% CI, 1.44 to 2.55), and f) Gastroenterologic IRR 1.42 (95% CI, 1.05 to 1.92). Cervical levels of TSCI showed an IRR of 1.70 (95% CI, 1.43 to 2.02), while thoracic levels had an IRR 1.98 (95% CI, 1.63 to 2.39). TSCI may be an individual risk factor of developing an autoimmune disease. There does not appear to exist a dose-response relationship from the level of injury. None.

The level of expression of HPV16 early transcripts is not associated with the natural history of cervical lesions.

The natural history of cervical cancer is closely linked to that of high-risk human papillomaviruses (HPV) infection. It is recognized that upon HPV DNA integration, partial or complete loss of the E2 open reading frame precludes expression of the corresponding protein, resulting in upregulation of the E6 and E7 viral oncoproteins. To better characterize HPV16 infection at the cervical level, viral load, viral DNA integration, and viral early transcript expression (E2, E5, and E6) were analyzed in a series of 158 cervical specimens representative of the full spectrum of cervical disease. Overall, the frequency of early transcript detection varied from 45% to 90% and tended to increase with lesion severity. In addition, the levels of E2, E5, and E6 transcript expression were slightly higher in high-grade lesions than in cervical specimens without abnormalities. Notably, early transcript expression was clearly associated with viral load, and no inverse correlation was found between the expression of E2 and E6 transcripts. No clear association was found between early transcript expression and HPV16 DNA integration, with the exception that samples with a fully integrated HPV16 genome did not harbor E2 or E5 transcripts. In conclusion, early HPV16 transcript expression appears to be associated with viral load rather than lesion grade. From a practical point of view, quantification of HPV16 early transcripts is difficult to translate into a relevant biomarker for cervical cancer screening.

The Lateral Corticospinal Tract Sign: An MRI Marker for Amyotrophic Lateral Sclerosis.

Background Radially sampled averaged magnetization inversion-recovery acquisition (rAMIRA) imaging shows hyperintensity in the lateral corticospinal tract (CST) in patients with motor neuron diseases. Purpose To systematically determine the accuracy of the lateral corticospinal tract sign for detecting patients with amyotrophic lateral sclerosis (ALS) at rAMIRA MRI. Materials and Methods This study included prospectively acquired data from participants in ALS and other motor neuron disease imaging studies at the University Hospital Basel, Switzerland. All participants underwent 3-T axial two-dimensional rAMIRA imaging at four cervical intervertebral disk levels. The lateral CST sign was defined as spinal cord white matter hyperintensity dorsolateral to the anterior horns, with higher signal intensity than in the dorsal columns on axial rAMIRA images. Marker accuracy was assessed in a study data set and in an independent validation data set. Postmortem rAMIRA imaging and histopathologic analysis were performed in one participant who died during the study. Results Participants with ALS (study data set: 38 participants [mean age, 61 years; IQR, 15 years], 22 male participants; validation data set: 10 participants [mean age, 61 years; IQR, 21 years], seven male participants), post-polio syndrome (study data set: 25 participants [mean age, 68 years; IQR, 8 years], 12 male participants), spinal muscular atrophy (study data set: 10 participants [mean age, 43 years; IQR, 14 years], eight male participants; validation data set: five participants [mean age, 38 years; IQR, 19 years], two male participants), and healthy control participants (study data set: 60 participants [mean age, 57 years; IQR, 20 years], 36 male participants; validation data set: 10 participants [mean age, 44 years; IQR, 17 years], seven male participants) were included. The sensitivity and specificity of rAMIRA for ALS were 60% (23 of 38) and 97% (91 of 94) in the study data set and 100% (10 of 10) and 93% (14 of 15) in the validation data set, respectively. Histopathologic analysis showed distinct loss of myelinated axons in the localization of the hyperintensities observed at rAMIRA imaging performed in situ and after organ extraction. Conclusion The recently defined marker at rAMIRA MRI may be a promising tool for assessing upper motor neuron degeneration in the lateral CST in patients with ALS. Clinical trials registration no. NCT03561623, NCT05764434, NCT06137612 © RSNA, 2024 Supplemental material is available for this article.

Shifting Trends in the Epidemiology of Cervical Spine Injuries: An Analysis of 11,822 Patients from the National Electronic Injury Surveillance System over Two Decades.

Cervical spine injuries (CSIs) are heterogeneous in nature and often lead to long-term disability and morbidity. However, there are few recent and comprehensive epidemiological studies on CSI. The objective of this study was to characterize recent trends in CSI patient demographics, incidence, etiology, and injury level. The National Electronic Injury Surveillance System was used to extract data on CSIs from 2002 to 2022. Weighted national estimates of CSI incidence were computed using yearly population estimates interpolated from U.S. census data. Data analysis involved extracting additional information from patient narratives to categorize injury etiology (i.e., fall) and identify CSI level. K-means clustering was performed on cervical levels to define upper versus lower cervical injuries. Appropriate summary statistics including mean with 95% confidence intervals and frequency were reported for age, sex, race, ethnicity, etiology, and disposition. Age between groups was compared using an independent weighted Z-test. All categorical variables were compared using Pearson chi-squared tests with Bonferroni correction for multiple comparisons. Ordinary least squares linear regression was used to quantify the rate of change of various metrics with time. A total of 11,822 patient records met the study criteria. The mean age of patients was 62.4 ± 22.7 years, 52.4% of whom were male and 61.4% of whom were White, 7.4% were Black, 27.8% were not specified, and the remaining comprised a variety of ethnicities. The most common mechanism of CSI was a fall (67.3%). There was a significant increase in the incidence of cervical injuries between 2003 and 2022 (p < 0.001). Unbiased K-means clustering defined upper cervical injuries as C1-C3 and lower cervical injuries as C4-C7. The mean age of patients with upper CSIs was 72.3 ± 19.6, significantly greater than the age of those with lower CSIs (57.1 ± 23.1, p < 0.001). Compared with lower CSI, White patients were more likely to have an upper CSI (67.4% vs. 73.7%; p < 0.001). While Black/African American (7.5% vs. 3.8%) and Hispanic (2.5% vs. 1.0%) patients were more likely to have a lower CSI (p < 0.001). Our study identified a significant increase in the incidence of CSIs over time, which was associated with increasing patient age. Our study detected a pragmatic demarcation of classifying upper injuries as C1-C3 and lower cervical injuries as C4-C7. Upper injuries were seen more often in older, White females who were treated and admitted, and lower injuries were seen more often in young, Black male patients who were released without admission.

Radiographic characterization of OPLL progression in patients receiving laminoplasty with a minimum of two-years follow-up

Ossification of the posterior longitudinal ligament (OPLL) is a common cause of degenerative cervical myelopathy (DCM) in Asian populations. Characterization of OPLL progression following laminoplasty remains limited in the literature. 29 patients with OPLL received cervical laminoplasty and a minimum of 2-years follow-up. Clinical and radiological surveillance occurred at 3-months, 6-months, 12-months post-op and then at yearly intervals. Transverse (anteroposterior) diameter and sagittal length of OPLL in relation to their cervical vertebral level of localisation was assessed upon immediate post-op radiographs compared to those obtained at subsequent follow-up. OPLL progression was defined as an increase in transverse dimensions and/or length by ≥ 2 mm. The average period of clinical follow-up was 6.7 ± 3.3 years. Upon latest follow-up, 79% of patients demonstrated at least 2 mm of transverse or longitudinal progression of OPLL. This corresponded to 2-years and 5-year progression rates of 54% and 71% respectively. OPLL located over C5 demonstrated the greatest transverse progression rate at (0.24 ± 0.34 mm / year). The mean overall longitudinal progression rate was 1.61 ± 2.06 mm / year. No patients experienced neurological decline resulting from OPLL progression requiring revision decompression during the period of post-operative observation. Characterizing transverse and longitudinal progression by cervical level via radiographs has implications in surgical planning for OPLL and should be consolidated upon post-operative CT/MRI scans as well as larger sample sizes.

Chitosan nanoparticles, Rose Bengal-chitosan activated photodynamic therapy as final irrigant on pushout bond strength, smear layer removal efficacy and antibacterial effectiveness against E.faecalis

AimImpact of final root canal disinfectants diode laser (DL), Rose Bengal photosensitizer (RBP), Chitosan Nanoparticles (CNPs), and CNPs modified RBP on Enterococcus faecalis (E.faecalis) survival rate, smear layer (SL) removal efficacy and push out bond strength (PBS) of resin sealer to the radicular dentin. Material and methodSingle rooted seventy-five human mandibular premolar teeth were sectioned at a level of cementoenamel (CEJ) and root canal treatment was performed using a ProTaper rotary instrument. To assess the antibacterial efficiency E.faecalis inoculation was performed using a pour plate method. The samples were arbitrarily allocated into five groups based on the final disinfectant received (n = 15) Group-1 (NaOCl+17 % EDTA), Group-2 (NaOCl+DL), Group-3 (NaOCl+CNPs), Group-4 (NaOCl+RBP activated by DL) and Group-5 (NaOCl+CNPs-RBP activated by DL). SEM analysis for SL removal was performed on five specimens from each group. Root canal obturation and sectioning were performed at cervical, middle, and apical levels. PBS and failure mode were analyzed using a universal testing machine (UTM) and stereomicroscope respectively. The data was subjected to analysis using one-way analysis of variance (ANOVA) and Tukey's post hoc test. ResultGroup 1 (NaOCl+17 % EDTA) (0.36 ± 0.01 CFU/mL) unveiled the maximum survival rate of tested bacteria. However, Group 5 (NaOCl+CNPs-RBP activated by DL) (0.11 ± 0.01 CFU/mL) displayed minimum survival of E.faecalis. The highest SL removal (1.44 ± 0.11) and bond integrity scores (12.23 ± 0.24 MPa) were recorded in the coronal section of Group 5 (NaOCl+ CNPs-RBP activated by DL) treated roots. However, the lowest removal of SL (3.15 ± 1.09) and PBS (7.24 ± 0.09 MPa) were recorded in Group 4 (NaOCl+RBP activated by DL) treated canals. CONCLUSIONCNPs-RBP activated by DL as the final irrigant provided satisfactory antibacterial activity, SL removal, and bond strength outcomes compared to other tested groups.

Outcomes of non-contiguous two-level anterior cervical discectomy and fusion in patients with degenerative cervical myelopathy: a retrospective study.

Non-contiguous two-level Anterior Cervical Discectomy and Fusion (ACDF) may be a viable option for patients with degenerative cervical myelopathy and imaging-evident spine and radicular compression at two non-contiguous cervical levels. The risk of hastening degeneration and triggering Adjacent Segment Disease at the spine levels located between the fused levels is a putative adverse event, which was assessed in a few studies. The aim of this study is to investigate the clinical outcomes of patients undergoing non-contiguous two levels ACDF and to assess biomechanical modifications at non-fused segments. We retrospectively reviewed all patients with noncontiguous two-level spine and radicular compression, who underwent simultaneous noncontiguous two-level ACDF at our center. We analyzed clinical and radiological outcomes and investigated the rate of adjacent segment disease. Radiographic parameters were calculated on pre- and postoperative images. Thirty-two patients underwent simultaneous noncontiguous two-level ACDF for cervical myelo-radiculopathy between 2015 and 2021 and were followed up for a mean period of 43.3 months. For all patients, the mJOA score significantly improved from 14.57 ± 2.3 to 16.5 ± 2.1 (p<0.01) and the NDI score significantly decreased from 21.45 ± 4.3 to 12.8 ± 2.3 (p<0.01) postoperatively. Cervical lordosis increased after surgery (from 9.65° ±9.47 to 15.12° ± 6.09); intermediate disc height decreased (5.68 mm ± 0.57 to 5.27 mm ±0.98); the ROMs of intermediate (from 12.45 ± 2.33 to 14.77 ± 1.98), cranial (from 14.63 ± 1.59 to 15.71 ± 1.02), and caudal (from 11.58 ± 2.32 to 13.33 ± 2.67) segments slightly increased. During follow-up assessment, in one patient the myelopathy worsened due to spine compression at the intermediate level. Simultaneous and non-contiguous two-level ACDF is a safe and effective procedure. The occurrence of postoperative adjacent and intermediate segment disease is rare.

Fatigue in early multiple sclerosis: MRI metrics of neuroinflammation, relapse and neurodegeneration.

Multiple sclerosis (MS) is a neuroinflammatory and neurodegenerative disease affecting the brain and spinal cord. Fatigue is a common disabling symptom from MS onset, however the mechanisms by which underlying disease processes cause fatigue remain unclear. Improved pathophysiological understanding offers potential for improved treatments for MS-related fatigue. MRI provides insights into in vivo neuroinflammatory activity and neurodegeneration, although existing evidence for imaging correlates of MS fatigue is mixed. We explore associations between fatigue and MRI measures in the brain and spinal cord to identify neuroinflammatory and regional neurodegenerative substrates of fatigue in early relapsing-remitting MS (RRMS). Recently diagnosed (<6 months), treatment-naive people with RRMS (n = 440) were recruited to a longitudinal multi-centre nationally representative cohort study. Participants underwent 3-Tesla brain MRI at baseline and one year. We calculated global and regional white and grey matter volumes, white matter lesion (WML) load and upper cervical spinal cord cross-sectional area levels C2-3, and assessed new/enlarging WMLs visually. Participants were classed as fatigued or non-fatigued at baseline according to the Fatigue Severity Scale (>/≤36). Disability and depression were assessed with the expanded-disability status scale and Patient Health Questionnaire, respectively. MRI measures were compared between fatigue groups, both cross-sectionally and longitudinally, using regression analyses. Higher disability and depression scores were observed for participants with fatigue, with a higher number of fatigued participants receiving disease-modifying treatments at follow-up. Structural MRI data for brain were available for n = 313 (45% fatigued) and for spinal cord for n = 324 (46% fatigued). Cervical spinal cord cross-sectional area 2-3, white and grey matter volumes decreased, and WML volume increased, over time for both groups (q < 0.05). However, no significant between-group differences in these measures were found either cross-sectionally or longitudinally (q > 0.05). The presence of new/enlarging WMLs (49% in fatigued; 51% in non-fatigued) at follow-up also did not differ between groups (q > 0.05). Our results suggest that fatigue is not driven by neuroinflammation or neurodegeneration measurable by current structural MRI in early RRMS. This novel negative finding in a large multi-centre cohort of people with recently diagnosed RRMS helps to resolve uncertainty in existing literature. Notably, we showed that fatigue is prevalent in patients without brain radiological relapse, who may be considered to have inactive disease. This suggests that symptom detection and treatment should remain a clinical priority regardless of neuroinflammatory disease activity. More sensitive objective biomarkers are needed to elucidate fatigue mechanisms in RRMS, and ultimately facilitate development of effective targeted treatments for this important 'hidden disability'.

Hepatocyte Growth Factor Delivery to Injured Cervical Spinal Cord Using an Engineered Biomaterial Protects Respiratory Neural Circuitry and Preserves Functional Diaphragm Innervation.

A major portion of spinal cord injury (SCI) cases occur in the cervical region, where essential components of the respiratory neural circuitry are located. Phrenic motor neurons (PhMNs) housed at cervical spinal cord level C3-C5 directly innervate the diaphragm, and SCI-induced damage to these cells severely impairs respiratory function. In this study, we tested a biomaterial-based approach aimed at preserving this critical phrenic motor circuitry after cervical SCI by locally delivering hepatocyte growth factor (HGF). HGF is a potent mitogen that promotes survival, proliferation, migration, repair, and regeneration of a number of different cell and tissue types in response to injury. We developed a hydrogel-based HGF delivery system that can be injected into the intrathecal space for local delivery of high levels of HGF without damaging the spinal cord. Implantation of HGF hydrogel after unilateral C5 contusion-type SCI in rats preserved diaphragm function, as assessed by invivo recordings of both compound muscle action potentials and inspiratory electromyography amplitudes. HGF hydrogel also preserved PhMN innervation of the diaphragm, as assessed by both retrograde PhMN tracing and detailed neuromuscular junction morphological analysis. Furthermore, HGF hydrogel significantly decreased lesion size and degeneration of cervical motor neuron cell bodies, as well as reduced levels surrounding the injury site of scar-associated chondroitin sulfate proteoglycan molecules that limit axon growth capacity. Our findings demonstrate that local biomaterial-based delivery of HGF hydrogel to injured cervical spinal cord is an effective strategy for preserving respiratory circuitry and diaphragm function.

Spinal stenosis at the cervical level: clinic, diagnosis and treatment

The article analyzes in detail the modern data on spinal canal stenosis in the cervical spine. The cause of its development may be various degenerative changes in the cervical spine that affect one or more anatomical structures, including vertebrae, intervertebral discs, joints and ligaments of the spine. The clinical forms are considered and the available data on the pathogenesis, diagnosis and treatment of cervical spinal stenosis are analyzed. The differential diagnosis of cervical myelopathy is complex, but a detailed clinical analysis, the use of modern neuroimaging methods make it possible to make a nosological diagnosis, assess the severity of the lesion, choose the appropriate therapy, the scope of surgical treatment and determine the prognosis of the disease. The differentiated nature of surgical decompression operations makes it possible to achieve the best results of neurological recovery of patients and compliance with the principles of minimal invasiveness.

High-risk human papillomavirus infection and cervical cytopathology: relationship with cervical nitric oxide levels

BackgroundNitric oxide (NO) may contribute to the persistence of high-risk human papillomavirus (hrHPV) infection, which has been linked to the development of premalignant lesions and cervical cancer. Our study aimed to examine the relationship between cervical NO metabolite (NOx) levels, hrHPV infection, and cytopathological findings. Additionally, we assessed cervical NOx levels as a biomarker for predicting hrHPV infection and epithelial atypia.MethodsThe study involved 74 women who attended the Gynecology and Obstetrics outpatient clinics at Cairo University Hospitals between November 2021 and August 2022. Cervical samples were subjected to Pap testing, assessment of NOx levels by the Griess method, and detection of hrHPV DNA by real-time polymerase chain reaction.ResultsHigh-risk HPV was detected in 37.8% of women. EA was found in 17.1% of cases, with a higher percentage among hrHPV-positive than negative cases (35.7% vs. 4.3%, p = 0.001). The most prevalent hrHPV genotype was HPV 16 (89.3%). The cervical NOx level in hrHPV-positive cases was significantly higher (37.4 µmol/mL, IQR: 34.5–45.8) compared to negative cases (2.3 µmol/mL, IQR: 1.2–9.8) (p = < 0.001). Patients with high-grade atypia showed significantly higher NOx levels (38.0 µmol/mL, IQR: 24.6–94.7) in comparison to NILM and low-grade atypia cases (5.0 µmol/mL, IQR: 1.6–33.3 and 34.5 µmol/mL, IQR: 11.7–61.7, respectively) (p = 0.006). Although the NOx levels among hrHPV-positive cases with low-grade atypia (40.4 µmol/mL, IQR: 33.3‒61.8) were higher than those with NILM (36.2 µmol/mL, IQR: 35.7‒44.0) and high-grade atypia (38.0 µmol/mL, IQR: 24.6‒94.7), the difference was not significant (p = 0.771). ROC curve analysis indicated that the cervical NOx cut-off values of > 23.61 µmol/mL and > 11.35 µmol/mL exhibited good diagnostic accuracy for the prediction of hrHPV infection and EA, respectively.ConclusionsThe high prevalence of hrHPV infection, particularly HPV 16, in our hospital warrants targeted treatment and comprehensive screening. Elevated cervical NOx levels are associated with hrHPV infection and high-grade atypia, suggesting their potential use as biomarkers for predicting the presence of hrHPV and abnormal cytological changes.

Nonquantitative CT scan Hounsfield unit as a determinant of cervical spine bone density.

Hounsfield unit (HU) values measured using CT have been increasingly recognized to stand as a reliable corollary to dual-energy x-ray absorptiometry (DEXA) scores in evaluating bone mineral density. The authors examined the correlation between cervical HU values and DEXA T- and Z-scores and determined novel cervical HU thresholds for determining bone quality classification. One hundred patients who underwent both cervical spine CT and DEXA, 85 patients who underwent both lumbar CT and DEXA, and 128 patients who underwent cervical and lumbar CT within 24 months at a single institution were included in this retrospective review. Two independent reviewers collected HU values from 3 cervical vertebral levels (C4-6) and 4 lumbar vertebral levels (L1-4), and the averaged values were used. Pearson's correlation coefficient analysis was performed to compare the association of cervical HU values with lumbar HU values and T- and Z-scores. The mean cervical HU values for each DEXA classification were calculated and compared. Receiver operating characteristic (ROC) curves were created to determine the threshold and its sensitivity and specificity for diagnosis. Cervical (C4-6) HU values and average, lumbar, and femoral T- and Z-scores had significant correlations (0.436 > r > 0.274, all p < 0.01). A strong positive correlation between cervical and lumbar HU values was found (r = 0.79, p < 0.01). The average cervical HU value of healthy patients was 361.2 (95% CI 337.1-385.3); of osteopenic patients, 312.1 (95% CI 290.3-333.8); and of osteoporotic patients, 288.4 (95% CI 262.6-314.3). There was a significant difference between the cervical HU values of healthy and osteopenic patients (p = 0.0134) and between those of healthy and osteoporotic patients (p = 0.0304). The cervical HU value of 340.98 was 73.5% specific and 57.9% sensitive for diagnosing osteopenia with an area under the ROC (AUROC) curve of 0.655. The cervical HU value of 326.5 was 88.9% specific and 63.2% sensitive for diagnosing osteoporosis with an AUROC curve of 0.749. This is the second large-scale study and first with a patient population from the United States to show that HU values obtained using cervical CT were significantly correlated with bone quality based on DEXA T- and Z-scores and to establish a cervical HU threshold for determining bone quality classification. These results show that cervical HU values can and should be used to predict poor bone quality in surgical cervical spine patients.

Epidemiological Characteristics of Traumatic Spinal Cord Injury in Saudi Arabia: A Systematic Review.

Traumatic spinal cord injury (TSCI) is a severe condition with high mortality and disability rates. Understanding the regional TSCI epidemiology may facilitate the development of targeted preventive initiatives and the optimization of resource allocation. The primary goal of this systematic review was to gather and analyze the existing literature on the frequency and characteristics of TSCI in Saudi Arabia. A literature search of PubMed, Web of Science, and Google Scholar was conducted in January 2024 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Observational studies reporting TSCI epidemiology in Saudi Arabia between 2010 and 2022 were included. Data on demographics, mechanisms, levels/severity, and outcomes were extracted. Methodological quality was assessed using the Newcastle-Ottawa Scale. Nine studies involving 2,356 TSCI cases were analyzed. Most patients were young males. Road traffic accidents were shown to be the predominant cause, accounting for 56.5-90.8% of cases. Thoracic (28.7-48.3%) and cervical (26.6-39%) levels were the most common. The extent of neurological deficits showed significant variation throughout the studies. This review provides a baseline understanding of TSCI epidemiology in Saudi Arabia but highlights critical gaps that future research should address. The review emphasizes the need for evidence-based interventions targeting road safety and falls, standardized cervical spine evaluation and management, and the use of validated metrics to optimize patient outcomes. Large-scale population-based studies with standardized methodologies are necessary to fully understand TSCI epidemiology, prognosis, and long-term disability burden in Saudi Arabia, leading to better prevention strategies and improved patient outcomes.