Evaluation Of Spinal Cord Injury Research Articles

Ultrasound localization microscopy based microvasculature evaluation of spinal cord injury with varying severities

Abstract The vasculature plays an important role in spinal cord function. Traumatic spinal cord injury (SCI) often results in a vascular disruption after primary insult, following secondary injury in neighbouring tissue. However, standard angiography methods such as digital subtraction angiography (DSA) still have difficulties in microvasculature imaging, especially for spinal cord with small size and non-rigid motion. The ultrasound localization microscopy (ULM) disrupts the compromise between penetration and resolution and provides super-resolution images of microvasculature. In this study, the applicability of the ULM for in vivo SCI evaluation was investigated on rat models with varying severities (different compression time durations correspond to mild and severe injury). Ultrasonic parameters including vessel saturation and blood velocity were measured via ULM. Basso, Beattie, Bresnahan (BBB) locomotion test was applied for injury severity validation and comparison with ultrasonic measurements.

Clinical Analysis of Microwave Ablation Combined with Decompression and Pedicle Screw Fixation in the Treatment of Spinal Metastases.

There is still controversy over the choice of treatment for end-stage spinal metastases. With the continuous development of microwave technology in spinal tumors, related studies have reported that microwave combined with techniques such as pedicle screw fixation and percutaneous vertebroplasty can achieve the purpose of tumor ablation, relieving spinal cord compression, enhancing spinal stability, effectively relieving pain, and reducing recurrence rates. This study aimed to analyze the effectiveness of microwave ablation combined with decompression and pedicle screw fixation in the palliative management of spinal metastases with pathological fractures. This retrospective study enrolled 82 patients with spinal metastases and pathological fractures treated between January 2016 and July 2020, with 44 patients undergoing pedicle screw fixation along with laminectomy (fixation group) and the remaining 38 receiving microwave ablation in addition to the treatment provided to group fixation (MWA group). Before surgery, all patients underwent pain assessment using the visual analogue scale (VAS) and evaluation of spinal cord injury using the Frankel classification. After surgery, the patients' prognoses were assessed using the Tomita score, modified Tokuhashi score system, and progression-free survival. Additionally, we compared operative time and blood loss between the two groups. Survival analysis utilized the Kaplan-Meier method with a log-rank test for group comparisons. Paired t-tests and the Mann-Whitney U test were applied to metric and non-normally distributed data, respectively. Neurological function improvement across groups was evaluated using the χ2 test. All patients were followed up for a median duration of 18 and 20 months in the fixation and MWA groups, respectively, with follow-up periods ranging from 6 to 36 months. Statistically significant reductions in postoperative VAS scores were observed in all patients compared with their preoperative scores. The MWA group exhibited reduced blood loss (t = 2.74, p = 0.01), lower VAS scores at the 1- and 3-month follow-ups (t = 2.34, P = 0.02; t = 2.83, p = 0.006), and longer progression-free survival than the fixation group (p = 0.03). Although the operation times in the MWA group were longer than those in the fixation group, this difference was not statistically significant (t = 6.06, p = 0.12). No statistically significant differences were found regarding improvements in spinal cord function between the two groups (p = 0.77). Compared with decompression and pedicle screw fixation for treating spinal metastases with pathological fractures, microwave ablation combined with decompression and pedicle screw fixation showed better outcomes in terms of pain control, longer progression-free survival, and lower blood loss without increasing operative time, which has favorable implications for clinical practice.

Attention-gated U-Net networks for simultaneous axial/sagittal planes segmentation of injured spinal cords.

Magnetic resonance imaging is currently the gold standard for the evaluation of spinal cord injuries. Automatic analysis of these injuries is however challenging, as MRI resolutions vary for different planes of analysis and physiological features are often distorted around these injuries. This study proposes a new CNN-based segmentation method in which information is exchanged between two networks analyzing the scans from different planes. Our aim was to develop a robust method for automatic segmentation of the spinal cord in patients having suffered traumatic injuries. The database consisted of 106 sagittal MRI scans from 94 patients with traumatic spinal cord injuries. Our method used an innovative approach where the scans were analyzed in series under the axial and sagittal plane by two different convolutional networks. The results were compared with those of Deepseg 2D from the Spinal Cord Toolbox (SCT), which was taken as state-of-the-art. Comparisons were evaluated using K-Fold cross-validation combined with statistical t-test results on separate test data. Our method achieved significantly better results than Deepseg 2D, with an average Dice coefficient of 0.95 against 0.88 for Deepseg 2D (p <0.001). Other metrics were also used to compare the segmentations, all of which showed significantly better results for our approach. In this study, we introduce a robust method for spinal cord segmentation which is capable of adequately segmenting spinal cords affected by traumatic injuries, improving upon the methods contained in SCT.

MRI Evaluation in Acute Spinal Trauma in Tertiary Center of Nepal

IntroductionSpine injury is one of the leading caused for disability in Nepal. Patients with trauma relatedspine injury leads to neurological dysfunction, focal deficits and even fatal life threating events.The timely intervention in acute spinal trauma injury could save the patients from disability andmortality risk. Imaging modalities like Xray, CT Scan and MRI helps in diagnosis and managementof spinal trauma. MRI plays crucial role in detection of spinal cord and soft tissue injuries. It issuperior than CT scan in evaluation of spinal cord injuries, ligament, soft issue structures, disc,and occult osseous injuries. The objective of this research is to evaluate MRI in acute spinal traumain tertiary center of Nepal. MethodsThis is descriptive hospital based observational study in those patients who were admitted andreferred in hospital for MRI with acute spinal trauma injury. Data were analysed by SPSS 2022. ResultsAcute spinal trauma is most common in male with ratio of 1.7 with the mean±SD of age was foundto be 50.98±19.26 years. Most common mode of injury were fall injury (76%). Most common spinalregion involved were lumbar (42%) followed by thoracic (36%), dorso-lumbar (14%) and cervical(8%) region respectively. Spinal cord contusion with edema, disc rupture, paravertebral collectionand ligament injury were seen. Most common type of fractures were simple compression fracture(72%), followed by burst fracture (16%), both (6%) and listhesis and sub/dislocations (6%). Spinalcord injury were seen in 22%, followed by disc rupture, paravertebral collection and ligamentinjury. ConclusionsMRI helps in evaluating vertebrae, spinal cord, ligament and disc injuries. We can assess the cordcontusion, edema and canal compression. It provides involvement, extension and severity of cordinjury. It endowed about outcome of surgery as well as conservative management in patient ofspinal injury.

Bulbocavernosus Reflex Has No Prognostic Features During the Acute Evaluation of Spinal Cord Injuries.

The bulbocavernosus reflex (BCR) has been used during the initial evaluation of a spinal cord injury patient as a metric to determine prognosis and whether the patient is in "spinal shock." This reflex has been less utilized over the last decade, and therefore a review was performed to assess the value of BCR in patient prognosis. The North American Clinical Trials Network (NACTN) for Spinal Cord Injury (SCI) is a consortium of tertiary medical centers that includes a prospective SCI registry. The NACTN registry data was analyzed to evaluate the prognostic implication of the BCR during the initial evaluation of a spinal cord injury patient. SCI patients were divided into those with an intact or absent BCR during their initial evaluation. Associations of participants' descriptors and neurological status on follow-up were performed, followed by associations with the presence of a BCR. A total of 769 registry patients with recorded BCRs were included in the study. The median age was 49 years (32-61 years), and the majority were male (n = 566, 77%) and white (n = 519, 73%). Among included patients, high blood pressure was the most common comorbidity (n = 230, 31%). Cervical spinal cord injury was the most common (n = 470, 76%) with fall (n = 320, 43%) being the most frequent mechanism of injury. BCR was present in 311 patients (40.4%), while 458 (59.6%) had a negative BCR within 7 days of injury or before surgery. At 6 months post-injury, 230 patients (29.9%) followed up, of which 145 had a positive BCR, while 85 had a negative BCR. The presence/absence of BCR was significantly different in patients with cervical (p = 0.0015) or thoracic SCI (p = 0.0089), or conus medullaris syndrome (p = 0.0035), and in those who were American Spinal Injury Association Impairment Scale grade A (p = 0.0313). No significant relationship was observed between BCR results and demographics, AIS grade conversion, motor score changes (p = 0.1669), and changes in pin prick (p = 0.3795) and light touch scores (p = 0.8178). In addition, cohorts were not different in surgery decision (p = 0.7762) and injury to surgery time (p = 0.0681). In our review of the NACTN spinal cord registry, the BCR did not provide prognostic utility in the acute evaluation of spinal cord injury patients. Therefore, it should not be used as a reliable marker for predicting neurological outcomes post-injury.

Diagnostic yield of magnetic resonance (MRI) imaging and treatment outcomes in patients with spinal cord trauma in, Nigeria: A single centre study

Background: Spinal cord trauma (SCT) is a devastating condition that can lead to significant neurological impairment and reduced quality of life. Magnetic Resonance Imaging (MRI) has been playing an increasingly important role in the management of spinal trauma patients. This study was designed to determine diagnostic yield of magnetic resonance imaging and the relationship between MRI findings and treatment outcomes in patients with trauma to the spinal cord. Materials and Method: A total of 245 patients who meet the inclusion criteria had their records and MRI findings evaluated retrospectively using convenience sampling method. The quantitative parameters that were used included: maximum spinal cord compression (MSCC), maximum canal compromise (MCC) and length of lesion while the qualitative parameters used are; intramedullary haemorrhage, cord oedema, cord swelling, disc herniation and soft tissue injury. Data such as cause of injury, anatomical level of injury, associated injury, and time of presentation, neurological/clinical presentation, and patterns of treatment, duration of hospitalization, ASIA classification and treatment outcome were collected. Results: The majority 53.47% (n = 131) had cervical spine involvement. Greater proportion 61.22 % (n=150) of spinal cord injuries were caused by road traffic accident (RTA). Most of the patients 33.06% (n=81) had only haemorrhage. Majority 51.02% (n = 125) had ASIA A and the least 4.49% (n = 11) had ASIA E classification. Among ASIA A patients, 21.63% (n = 53) had only haemorrhage while 29.39% (n= 72) had both haemorrhage and Oedema. Out of 53 ASIA A patients that had only haemorrhage, 21.57% (n = 11) of the ASIA A patients had incomplete recovery while 78.43% (n = 42) had no recovery. Out of the 72 ASIA A patients that had both haemorrhage and oedema, 18.06% (n = 13) had incomplete recovery while 81.94% (n = 59) had no recovery. Conclusion: The majority of the patients had cervical spine cord injuries and RTA was the most common causes of spinal cord injuries. Most of the patients had ASIA a classes of spinal cord injuries with more of them having only haemorrhage. The patients’ recovery rate was very poor across all the various classes of ASIA and MRI has shown to be good prognostic tools for the evaluation of spinal cord injuries.

Dual detection of spinal cord injury biomarkers in rat model using gold nanorod array substrate based on surface-enhanced Raman scattering

Tumor necrosis factor alpha (TNF­α) and glial fibrillary acidic protein (GFAP) are candidate biomarkers for early diagnosis and evaluation of spinal cord injury (SCI). In fact, their concentrations in serum, plasma, or cerebrospinal fluid are highly correlated with the SCI severity and neurological prognosis. Therefore, development of a rapid, ultrasensitive, and accurate technique for dual-detection of these important biomarkers is critical for SCI diagnosis, monitoring, and recovery assessment. We synthesized gold nanorods (AuNRs) with stable aspect ratio and fabricated an AuNR array parallelly aligned on a substrate using evaporation-induced self-assembly. The uniform morphology and neat arrangement of the AuNRs produce many hotspots that increase the sensitivity and reproducibility of the array. For dual detection of TNF-α and GFAP, the self-assembled AuNR array substrate was modified with anti-TNF­α and anti-GFAP. Then, special Raman probe molecules, specific antibodies, and AuNRs were combined to fabricate surface-enhanced Raman scattering (SERS) tags of AuNR@4-MPBA and AuNR@NBA modified with anti-TNF­α and anti-GFAP, respectively. Sandwich immunoassay using standard solutions of TNF­α and GFAP provided limits of detection of 0.023 and 0.018 pg/mL, respectively. The detector was evaluated on concentrations of TNF­α and GFAP in plasma of SCI rat models. Cross-validation against ELISA (enzyme-linked immunosorbent assay) indicated that the SERS sandwich immunoassay detector based on AuNR array substrate has a high dual-detection accuracy. Overall, the proposed detector provides high sensitivity, reproducibility, stability, and accuracy, and it correctly performs dual detection. The fabricated detector platform seems promising for detection of multiple molecules to achieve early and accurate disease diagnosis in clinical practice.

Diffusion tensor imaging predicting neurological repair of spinal cord injury with transplanting collagen/chitosan scaffold binding bFGF.

Prognosis and treatment evaluation of spinal cord injury (SCI) are still in the long-term research stage. Prognostic factors for SCI treatment need effective biomarker to assess therapeutic effect. Quantitative diffusion tensor imaging (DTI) may become a potential indicators for assessing SCI repair. However, its correlation with the results of locomotor function recovery and tissue repair has not been carefully studied. The aim of this study was to use quantitative DTI to predict neurological repair of SCI with transplanting collagen/chitosan scaffold binding basic fibroblast growth factor (bFGF). To achieve our research goals, T10 complete transection SCI model was established. Then collagen/chitosan mixture adsorbed with bFGF (CCS/bFGF) were implanted into rats with SCI. At 8 weeks after modeling, implanting CCS/bFGF demonstrated more significant improvements in locomotor function according to Basso-Beattie-Bresnahan (BBB) score, inclined-grid climbing test, and electrophysiological examinations. DTI was carried out to evaluate the repair of axons by diffusion tensor tractgraphy (DTT), fractional anisotropy (FA) and apparent diffusion coefficient (ADC), a numerical measure of relative white matter from the rostral to the caudal. Parallel to locomotor function recovery, the CCS/bFGF group could significantly promote the regeneration of nerve fibers tracts according to DTT, magnetic resonance imaging (MRI), Bielschowsky's silver staining and immunofluorescence staining. Positive correlations between imaging and locomotor function or histology were found at all locations from the rostral to the caudal (P < 0.0001). These results demonstrated that DTI might be used as an effective predictor for evaluating neurological repair after SCI in experimental trails and clinical cases.

Identification of serum exosomal microRNAs in acute spinal cord injured rats

It is important to find specific and easily detectable diagnostic markers in acute stage of spinal cord injury for guiding treatment and estimating prognosis. Although, microRNAs are attractive biomarkers, there is still no uniform standard for clinical evaluation of spinal cord injury based on “free circulation” miRNA spectrum. The reason may be that miRNA analysis from biological fluids is influenced by many pre-analysis variables. Exosome miRNAs are widely distributed in body fluids and have many advantages comparing with free miRNAs. The specific miRNAs in the central nervous system can be transported to the peripheral circulation and concentrated in exosomes. Therefore, we hypothesized that there might be some physiological changes associated with spinal cord injury in serum exosomal miRNAs. Using next-generation sequencing, miRNA profiles in serum exosomes of sham and acute spinal cord injury rats were analyzed, and integrative bioinformatics were used to analyze the function and regulation of putative target genes. The results showed that acute spinal cord injury can lead to changes in miRNA expression in the circulating exosomes. The changed miRNAs and their associated pathways may explain the pathology of acute spinal cord injury. More importantly, we determined serum exosomal miR-125b-5p, miR-152-3p, and miR-130a-3p are specific and easily detectable diagnostic markers in acute spinal cord injury. More interestingly, we also found some valuable known and novel miRNAs. Further bioinformatics analysis and functional research will be of great help to make clear their role in the pathological process of spinal cord injury and judging whether they can be used as diagnostic markers. Impact statement This research hypothesized that there might be some physiological changes associated with SCI in serum exosomal miRNAs. Using next-generation sequencing, miRNA profiles in serum exosomes of sham and acute SCI rats were analyzed, and integrative bioinformatics were used to analyze the function and regulation of putative target genes. The results showed that acute SCI can lead to changes in miRNA expression in the circulating exosomes. The changed miRNAs and their associated pathways may explain the pathology of acute SCI. More importantly, we determined serum exosomal miR-125b-5p, miR-152-3p, and miR-130a-3p are specific and easily detectable diagnostic markers in acute SCI.

Visualize and quantify the structural alteration of the rat spinal cord injury based on multiphoton microscopy.

The development of imaging technique to visualize and quantify the structural alteration of the spinal cord injury (SCI) may lead to better understanding and treatments of the injuries. In this work, multiphoton microscopy (MPM) based on two-photon excited fluorescence (TPEF) and second-harmonic generation (SHG) was tentatively applied to quantitatively visualize the cellular microstructures of SCI to demonstrate the feasibility and superiority of MPM in SCI imaging. High-contrast MPM images of normal and injured spinal cord tissue were obtained for comparison. Moreover, the changes of injured spinal cord were characterized by the quantitative analysis of the MPM images. These results showed that MPM combined with quantitative method has the ability to identify the characteristics of spinal cord injury including the changes in the contents of nerve fibers and extracellular matrix. With the advancement of MPM, we believe that this technique has great potential to provide the histological diagnosis for the monitoring and evaluation of SCI.

Combined Strategy for a Reliable Evaluation of Spinal Cord Injury Using an in vivo Model.

A complete neurological exam contributes in establishing spinal cord injury severity and its extent by identifying the damage to the sensory and motor pathways involved in order to address a more case-specific and precise pharmacological therapy. However, assessment of neurologic function in spinal cord injury models is usually reported by using sensory or motor tests independently. A reliable integral method is needed to precisely evaluate location and severity of the injury at baseline and, in further assessments, to establish the degree of spontaneous recovery. A combination of sensation-based tests and motor-based tests was used to evaluate impaired neurologic function after spinal cord injury and the degree of spontaneous recovery, in different stages, on an in vivo model. Combined neurologic evaluation was useful to establish location and severity of the injury in all animals and also to detect degrees of spontaneous recovery at different stages after the injury. Comparisons of neurological function were assessed in time-days and groups between BBB motor score, latency maintenance of posture, locomotion and latency presentation of grooming before and after the injury. Our results suggest that a combined assessment strategy, including sensory and motor tests, can lead to better evaluation of spinal cord injury severity and location, and documentation of the extent of spontaneous recovery following SCI and identify specific motor and sensory pathway integrity. In conclusion, a combined assessment strategy provides a concise method for evaluating the impact of interventions in experimental models of SCI.

DTI and pathological changes in a rabbit model of radiation injury to the spinal cord after 125I radioactive seed implantation.

Excessive radiation exposure may lead to edema of the spinal cord and deterioration of the nervous system. Magnetic resonance imaging can be used to judge and assess the extent of edema and to evaluate pathological changes and thus may be used for the evaluation of spinal cord injuries caused by radiation therapy. Radioactive 125I seeds to irradiate 90% of the spinal cord tissue at doses of 40-100 Gy (D90) were implanted in rabbits at T10 to induce radiation injury, and we evaluated their safety for use in the spinal cord. Diffusion tensor imaging showed that with increased D90, the apparent diffusion coefficient and fractional anisotropy values were increased. Moreover, pathological damage of neurons and microvessels in the gray matter and white matter was aggravated. At 2 months after implantation, obvious pathological injury was visible in the spinal cords of each group. Magnetic resonance diffusion tensor imaging revealed the radiation injury to the spinal cord, and we quantified the degree of spinal cord injury through apparent diffusion coefficient and fractional anisotropy.

Strain rate dependent behavior of the porcine spinal cord under transverse dynamic compression.

The accurate description of the mechanical properties of spinal cord tissue benefits to clinical evaluation of spinal cord injuries and is a required input for analysis tools such as finite element models. Unfortunately, available data in the literature generally relate mechanical properties of the spinal cord under quasi-static loading conditions, which is not adapted to the study of traumatic behavior, as neurological tissue adopts a viscoelastic behavior. Thus, the objective of this study is to describe mechanical properties of the spinal cord up to mechanical damage, under dynamic loading conditions. A total of 192 porcine cervical to lumbar spinal cord samples were compressed in a transverse direction. Loading conditions included ramp tests at 0.5, 5 or 50 s-1 and cyclic loading at 1, 10 or 20 Hz. Results showed that spinal cord behavior was significantly influenced by strain rate. Mechanical damage occurred at 0.64, 0.68 and 0.73 strains for 0.5, 5 or 50 s-1 loadings, respectively. Variations of behavior between the tested strain rates were explained by cyclic loading results, which revealed behavior more or less viscous depending on strain rate. Also, a parameter (stress multiplication factor) was introduced to allow transcription of a stress-strain behavior curve to different strain rates. This factor was described and was significantly different for cervical, thoracic and lumbar vertebral heights, and for the strain rates evaluated in this study.

Feasibility of 3.0 T diffusion-weighted nuclear magnetic resonance imaging in the evaluation of functional recovery of rats with complete spinal cord injury.

Diffusion tensor imaging is a sensitive way to reflect axonal necrosis and degeneration, glial cell regeneration and demyelination following spinal cord injury, and to display microstructure changes in the spinal cord in vivo. Diffusion tensor imaging technology is a sensitive method to diagnose spinal cord injury; fiber tractography visualizes the white matter fibers, and directly displays the structural integrity and resultant damage of the fiber bundle. At present, diffusion tensor imaging is restricted to brain examinations, and is rarely applied in the evaluation of spinal cord injury. This study aimed to explore the fractional anisotropy and apparent diffusion coefficient of diffusion tensor magnetic resonance imaging and the feasibility of diffusion tensor tractography in the evaluation of complete spinal cord injury in rats. The results showed that the average combined scores were obviously decreased after spinal cord transection in rats, and then began to increase over time. The fractional anisotropy scores after spinal cord transection in rats were significantly lower than those in normal rats (P < 0.05); the apparent diffusion coefficient was significantly increased compared with the normal group (P < 0.05). Following spinal cord transection, fractional anisotropy scores were negatively correlated with apparent diffusion coefficient values (r = –0.856, P < 0.01), and positively correlated with the average combined scores (r = 0.943, P < 0.01), while apparent diffusion coefficient values had a negative correlation with the average combined scores (r = –0.949, P < 0.01). Experimental findings suggest that, as a non-invasive examination, diffusion tensor magnetic resonance imaging can provide qualitative and quantitative information about spinal cord injury. The fractional anisotropy score and apparent diffusion coefficient have a good correlation with the average combined scores, which reflect functional recovery after spinal cord injury.

Development of an Improved Rabbit Model of Spinal Cord Compression by Embolectomy Catheter

The aim of this experimental study was to evaluate the efficacy of epidural balloon inflation into the unroofed spinal cord for the creation of a experimental spinal cord injury model in rabbits. Ten New Zealand white rabbits were used for this study. Before operation and after anasthesia with 60 mg/kg ketamine and 6 mg/kg xylazine. A midline skin incision was done on the lumbar skin at the level of L1-L4 lumbar vertebrae. Paravertebral muscles were bluntly dissected bilaterally. A microhemilaminotomy was done in the right L3 lamina close to the midline. An arteial embolectomy catheter was inserted into the spinal column between the bone and dura mater to the level of L1-L2 intervertebral space. The microballoon was gradually inflated by using a volume-controlled microballoon inflation syringe over a period of 3 minutes. The microballoon was deflated 8 minutes later and removed completely from the epidural space. All rabbits were paraplegic after the operation. In conclusion, this experimental study demonstrated that the microballoon inflation technique is a very successful method for the evaluation of spinal cord injury in rabbits. Unroofing of the spinal column is extremely important because decompression may be an effective treatment in spinal cord injury. A suitable spinal injury model was created, that is minimally invasive, uniform and easily reproducible.

DIFFERENTIAL DIAGNOSIS OF SPINAL CORD CONCUSSION AND CONTUSION WITHOUT MRI CHANGES IN CHILDREN

Objective. To prove a significance of a diagnostic table for effective diagnosis and evaluation of spinal cord injury in children. Material and Methods. Retrospective analysis of 191 case records of children with spinal cord injury without the evidence of hemorrhage or compression was performed. Specific clinical manifestations were analyzed using Wald’s statistical sequential analysis with calculation of diagnostic factor informative value in accordance with A. Kulback. Results. Diagnostic value of clinical signs was calculated on the basis of statistically analyzed data of initial examination. The analyzed incidence of clinical signs became the ground for diagnostic table used for differential diagnosis of spinal cord injury in children. Conclusion. Functional outcome of the spinal cord contusion in children can be good; and application of the suggested diagnostic table improves the quality of spinal cord injury diagnosis.

Effect of intrathecal papaverine on blood flow and secondary injury in injured cord

Experimental laboratory investigations with a model of neurotrauma in Macaca rhesus. The present study evaluates whether intrathecal papaverine induces changes in spinal cord blood flow (SCBF) of injured spinal cord and prevents secondary injury. Institute of Spinal Cord Injury, Sun Yat-sen University, China. After laminectomy was performed and contusive spinal cord injuries were induced in adult female Macaca rhesus, three received intrathecal papaverine, and three received saline 0.9% for control. SCBF was registered by laser-Doppler recording technique continuously for 180 min after injection. Histological analyses and microvessel density (MVD) were used for evaluation of spinal cord injury, and the percentage of spared spinal cord area was calculated. Mean arterial blood pressure showed no significant change in both groups. In the papaverine group, SCBF recovered to 81.35+/-7.8% of baseline at 15 min, 75.24+/-6.3% at 30 min, 73.38+/-2.3% at 90 min and 72.57+/-4.1% at 180 min after the completion of infusion. SCBF was significantly higher than the control groups (P<0.01). There was no occlusion of the arteries, but occluded veins were identified at the injured site. The MVD in the spinal cord of the control group was significantly lesser than the papaverine group (P<0.01). Luxol Fast Blue staining showed that intrathecal papaverine reduced myelin loss in the lesion 2 weeks after injury (P<0.05). Intrathecal administration of papaverine increased SCBF in non-human primates. It is likely that the effects of papaverine can reduce secondary injury in spinal cord injured Macaca rhesus.

Determining prognosis after spinal cord injury

Introduction Disability following traumatic spine injury often requires assessment for judicial reasons. Objective To determine the optimum time to carry out a medico-legal evaluation. Methods Retrospective study (1995–2000) of patients with traumatic spine injury with a follow-up of five years. The American Spinal Injury Association (ASIA) scale was used to determine level and extent of the injury. Statistical analysis by SPSS 11.0. Results and discussion 173 injuries were analyzed (39.3% ASIA A; 15.6% ASIA B; 29.47% ASIA C; 15.6% ASIA D). Neurological improvement was detected in 35.83%, more frequently in incomplete injuries. ASIA A injuries remained mainly complete from admission to discharge and in no case reached functional levels. Only a third of ASIA B patients showed improvement, of whom 33.3% were functional. Improvement in ASIA C patients was 76.4%, these and all ASIA D patients were functional on discharge. The condition a year after the injury remained unchanged in all cases, regardless of the extent of injury. Patients who showed improvement did so early on, mainly during hospitalization. Conclusions The optimum time for evaluation of spinal cord injury for medicolegal purposes is at one year after the injury. In cases of complete injury, evaluation can be carried out on discharge with no need to wait for one year.

A New Minimally Invasive Experimental Spinal Cord Injury Model in Rabbits

The aim of this experimental study was to evaluate the effectivity of epidural microballoon inflation into the unroofed spinal column for the creation of a new experimental spinal cord injury model in rabbits. 10 New Zealand white rabbits were used for this study. Before operation and after anasthesia with 50 mg/kg ketamine and 8 mg/kg xylazine, spinal evoked potentials (SEP) were recorded in all rabbits. A midline skin incision was done on the lomber skin at the level of L1-L4. Paravertebral muscles were dissected bilaterally. A microhemilaminotomy was done in the right L3 lamina close to the midline by using Midas-rex micro-diamond drill instruments. The ligamentum flavum was opened and removed with microscissors. A microballoon was inserted into the spinal column between the bone and dura mater to the level of T12. The microballoon was inflated by using a pressure- and volume-controlled microballoon inflation device. Pre-injury and post-injury SEPs were recorded. The microballoon was deflated 15 minutes later and removed completely from the epidural space. 24 hours later the SEP study was repeated. Following microballoon inflation the SEP waves dropped to the basal level. All rabbits were paraplegic after the operation. In conclusion, this experimental study demonstrated that the microballoon inflation technique is a very successful method for the evaluation of spinal cord injury in rabbits. Unroofing of the spinal column is extremely important because decompression may be an effective treatment in spinal cord injury. Also the traumatic effect of aneurysm clips represents a different type of injury to the spinal cord. This new model may be used in experimental studies of spinal cord injury in rabbits.

A Global Perspective on Spinal Cord Injury Epidemiology

Spinal cord injury (SCI) is a devastating condition often affecting young and healthy individuals around the world. This debilitating condition not only creates enormous physical and emotional cost to individuals but also is a significant financial burden to society at large. This review was undertaken to understand the global impact of SCI on society. We also attempted to summarize the worldwide demographics and preventative strategies for SCI in varying economic and climatic environments and to evaluate how cultural and economic differences affect the etiology of SCI. A PUBMED database search was performed in order to identify clinical epidemiological studies of SCI within the last decade. In addition, World Bank and World Health Organization websites were used to obtain demographics, economics, and health statistics of countries of interest. A total of 20 manuscripts were selected from 17 countries. We found that SCI varies in etiology, male-to-female ratios, age distributions, and complications in different countries. Nations with similar economies tend to have similar features and incidences in all the above categories. However, diverse methods of classifying SCI were found, making comparisons difficult. Based upon these findings, it is clear that the categorization and evaluation of SCI must be standardized. The authors suggest improved methods of reporting in the areas of etiology, neurological classification, and incidence of SCI so that, in the future, more useful global comprehensive studies and comparisons can be undertaken. Unified injury prevention programs should be implemented through methods involving the Internet and international organizations, targeting the different etiologies of SCI found in different countries.