Posttraumatic Spinal Cord Cysts Research Articles

CSF - injected contrast medium enhances post-traumatic spinal cord cysts. An experimental study in rats.

Spinal cord injury (SCI) is still one of the most challenging problems in neurosurgical practice. One of the major obstacles to neural regeneration following trauma is the formation of glial scarring and post-traumatic cysts which acts against proper growth of axons through the site of injury. Cerebrospinal fluid (CSF) delivery of bioactive agents into cystic cavities could represent a promising therapeutic strategy. In the present study, we investigated specifically the dynamics of intradural delivery of contrast medium and its relocation into post-traumatic cysts in an experimental model of spinal cord cryoinjury in rats. 32 male Sprague Dawley SPF rats were submitted to injury as previously described. Omnipaque-240 was injected either into the cisterna magna or at the level of the cauda equina. Subsequently, cerebral CT scan examinations were performed in order to check the CSF dynamics of the contrast medium. There was a steady accumulation of contrast medium into post-traumatic cysts as early as five minutes after injection. A dosage of 65 mg of iodine per kilogram ensured an adequate feeling of the cysts at an average of 30 minutes. Our data indicate that intraspinal injection of bioactive agents can easily reach the site of injury and fill post-traumatic cysts. This could represent an interesting potential therapeutic protocol for SCI.

PARTICIPATION OF HUMAN OLFACTORY ENSHEATHING CELLS IN NEUROREGENERATION PROCESSES IN EXPERIMENTAL SPINAL CORD INJURIES

The experimental post-traumatic spinal cord cysts were modeled. The efficiency of transplantation of the human olfactory ensheathing cells into cysts to restore the motor activity of the hind limbs of rats was shown. Survival and migration of ensheathing cells in vivo, their participation in the remyelination were shown.

Study of the Therapeutic Efficiency of Transduced Olfactory Ensheathing Cells in Spinal Cord Cysts.

Posttraumatic spinal cord cysts are difficult to treat with medication and surgery. Gene-cell therapy is a promising area of treatment for such patients. However, optimal gene-cell construct for this therapy has not been developed. We investigated the therapeutic efficiency of human olfactory ensheathing cells (OECs) transduced by adenoviral vector encoding the mature form of brain-derived neurotrophic factor (mBDNF) in spinal cord cysts. The adenoviral vectors Ad5/35-CAG-mBDNF and Ad5/35-CAG-Fluc were constructed. Spinal cysts were modeled in female Wistar rats. We selected animals at the early and intermediate stages of recovery with scores to 13 according to the Basso, Beattie and Bresnahan (BBB) scale. The efficiency of therapy was evaluated by BBB tests. No cytotoxicity was detected using the Resazurin/AlamarBlue assay for both vectors at multiplicity of infection (MOIs) of 1, 5, and 25. There was an increase in the proliferation of cells treated with Ad5/35-CAG-mBDNF at MOIs of 5 and 25. The hind limb mobility after the transplantation of Ad5/35-CAG-mBDNF- and Ad5/35-CAG-Fluc-transduced human OECs and nontransduced OECs had approximately the same tendency to improve. Cyst reduction was observed with the transplantation of all the samples. Although Ad5/35-CAG-mBDNF-transduced OECs had high BDNF expression levels in vitro, these cells lacked positive effect in vivo because they did not exhibit significant effect concerning functional test when comparing the groups that received the same numbers of OECs. The therapeutic efficiency of transduced OECs appears to be due to the cell component. The autological and tissue-specific human OECs are promising for the personalized cell therapy. It is extremely important to test new gene-cell constructs based on these cells for further clinical use.

The Effect of Transplantation of Olfactory Ensheathing Cells on the Size of Posttraumatic Spinal Cord Cysts

We studied the effect of transplantation of ensheathing cells obtained from the olfactory mucosa of rats and humans on the size of posttraumatic spinal cord cysts. MRI examination showed that transplantation of these cells into experimental posttraumatic cysts of the spinal cord led to a significant decrease in cyst volume and even their complete disappearance in two animals receiving transplantation of rat or human cells. These findings attested to regenerative processes developing as a result of ensheathing cell transplantation. Further studies in this field will be aimed at elucidation of the mechanisms underlying spinal cord regeneration in the area of posttraumatic cysts after transplantation of ensheathing cells.

APPLICATION OF NEUROTROPHIC FACTORS BDNF AND NT-3 IN CELL THERAPY OF EXPERIMENTAL POSTTRAUMATIC SPINAL CORD CYSTS

The experimental post-traumatic spinal cord cysts were modeled. It has been shown that NT-3 enhances the effectiveness of the use of human olfactory ensheathing cells in the treatment of experimental spinal cord cysts.

Влияние трансплантации обкладочных клеток обонятельной выстилки на изменение размеров посттравматических кист спинного мозга

Влияние трансплантации обкладочных клеток обонятельной выстилки на изменение размеров посттравматических кист спинного мозга

Efficiency of Human Olfactory Ensheathing Cell Transplantation into Spinal Cysts to Improve Mobility of the Hind Limbs.

The pathological processes developing after spinal cord injuries often lead to formation of cysts. Existing surgical and medical methods are insufficient for treatment of post-traumatic spinal cord cysts. One of the emerging tools is cell therapy. Olfactory ensheathing cells (OECs) are perspective cells for cell therapy. In this study, we demonstrated that human OEC transplantation is effective in experimental spinal cysts. For our experiments, we selected animals only at the intermediate stage of recovery with scores from 8 to 13 according to the Basso, Beattie, and Bresnahan (BBB) scale. Cells were transplanted in different quantities (0.75 and 1.5 million) into the fully formed cysts and in the areas of injury without cysts. Improvement of limb mobility after human OEC transplantation into post-traumatic cysts was shown. In the group of rats with cysts, time-dependent increase in the BBB score was observed in subgroups treated with 0.75 and 1.5 million OECs with no statistically significant time-dependent dynamics of BBB values in the control group. When all three subgroups (control and two OEC doses) were compared, the Kruskal-Wallis test showed the presence of differences between subgroups after 1, 3, and 4 weeks of treatment with evidence of divergence increase. There was no statistically significant difference between the two doses of OEC treatment. The human OECs in the experiments without cysts were not effective. It was also shown that PKH26-labeled human OECs survive throughout the experiment and migrate to nearby areas of the cyst. Therefore, it was found that it is effective to transplant human OECs into fully formed cysts. In the future, autologous OECs can be used to personalize the treatment of patients with spinal cysts.

Isolation of Rat Olfactory Ensheathing Cells and Their Use in the Therapy of Posttraumatic Cysts of the Spinal Cord.

We evaluated the efficacy of rat olfactory ensheathing cells in the therapy of experimental cysts of the spinal cord. Improvement of the motor function of the hind limbs after transplantation of the olfactory ensheathing cells into the posttraumatic spinal cord cysts rats was found. We also determined the required number of cells for transplantation and demonstrated a neuroprotective effect of this dosage. For further clinical studies, autologous tissue-specific cell preparation of olfactory ensheathing cells has to be created. Cell therapy in combination surgical and pharmacological treatment will substantially improve the quality of life of patients with posttraumatic spinal cord cysts.

POSTERIOR INTERNAL FIXATION WITH SHAPE-MEMORY TIGHTENING CLAMPS IN THE TREATMENT OF LOWER CERVICAL VERTEBRA ANTERIOR DISLOCATIONS

Objective. To analyze adaptation of shape-memory dynamical clamps to anatomical and morphological features of the cervical spine. Material and Methods. Fifty five patients with lower cervical spine dislocations were operated on by posterior fixation with tightening clamps. In 14 (25.0 %) patients the open reduction of dislocated vertebra and posterior clamp fixation were accompanied by the anterior fusion with a porous NiTi implant, while 42 (75.0 %) patients underwent only posterior operation. The treatment results in patients with spinal cord injury were evaluated using A.H. Martins criteria and ASIA/IMSOP scale. Delayed results were estimated 1–5 years after operation in 42 (75.0 %) patients. Results. Treatment results were assessed as good in 88.1 % of cases. Radiological examination revealed a decrease in disc height at injured and adjacent levels not more than 1 mm; instability, or kyphotic deformity were not registered. Implant area did not include the signs of resorption or osteosclerosis. Neurological disorders caused by posttraumatic spinal cord cyst were observed in one (2.4 %) patient in 1.5 years after surgery. In 4 (9.5 %) patients who underwent anterior and posterior fixation the treatment results were assessed as fair. Patients disability period was 96 ± 38 days. Conclusion. Two-axial fixation with coupled tightening clamps of shape-memory material provides the reliable stabilization of the injured vertebral motion segment. Preliminary posterior fixation for unstable injury facilitates the optimal performing of anterior interbody fusion with porous implants and ensures its absolute stability.

Posttraumatic Spinal Cord Cyst:Three Cases Report and Literature Review

Posttraumatic Spinal Cord Cyst:Three Cases Report and Literature Review

Implications of focal spinal cord lesions following trauma: evaluation with magnetic resonance imaging.

In a series of 15 patients who underwent early and follow up magnetic resonance imaging following spinal cord injury, those with focal spinal cord abnormalities such as cord contusion or haematoma had worse neurological outcomes, and most developed spinal cord cysts, showing as well-defined areas of CSF intensity within the cord on T1 weighted images. Patients with cord oedema initially, had better outcomes, with the development of residual areas of myelomalacia. These observations suggest that patients with focal initial spinal cord abnormalities may have an increased risk of developing posttraumatic spinal cord cysts, which may be associated with the development of delayed neurological deterioration.

Post-traumatic spinal cord cysts evaluated by magnetic resonance imaging

In order to determine a more accurate prevalence of post-traumatic spinal cord cysts (PTSCC) in spinal cord injured (SCI) patients, we retrospectively reviewed magnetic resonance scans from symptomatic imaging and asymptomatic SCI patients. We found the incidence of PTSCC to be 51% in our patient population. The only symptom that correlated to the presence of a cyst was spasticity. The cyst develops at the site of injury and appears to be a common sequela of SCI. We believe that conservative treatment is indicated in most patients with a PTSCC.

Cine MR in the evaluation of normal and abnormal CSF flow: intracranial and intraspinal studies

Evaluation of intracranial and intraspinal CSF flow was accomplished by the use of cardiac gated gradient echo magnetic resonance (MR) technique. Normal patterns of pulsatile flow within the ventricles, cisterns and cervical subarachnoid space were established by this technique and these observations were compared to prior description of CSF flow. With systole there is downward (caudal) flow of CSF in the aqueduct of Sylvius, the foramen of Magendie, the basal cisterns and the dorsal and ventral subarachnoid spaces while during diastole, upward (cranial) flow of CSF in these same structures is seen. The relationships between the cardiac cycle and the CSF pulsations are demonstrated on both magnitude reconstruction and phase reconstruction MR images. Calculations of actual fluid velocity within CSF containing spaces can be obtained from the phase reconstruction images and holds promise for a more accurate analysis of CSF flow. In conditions which result in alterations of flow, cine MR dramatically shows either obstruction or excessively turbulent flow within the CSF pathways. The site of obstructed flow whether in the third ventricle, aqueduct, fourth ventricle, or subarachnoid space can be appreciated by changes in or absence of the normal hypointense signal. Cystic cord lesions such as congenital syringohydromyelia and posttraumatic spinal cord cysts may show pulsatile flow of CSF, a fact which can relate to progressive enlargement of these cysts. The distinction between myelomalacia and cyst formation in the cord is facilitated by the technique. Although the use of cine MR for the analysis of CSF flow is in its infancy, our experience indicates that this technique is useful in a wide range of pathological conditions including, but not limited to, conditions resulting in hydrocephalus or cystic cord lesions.

MRI of the chronically injured cervical spinal cord.

Thirteen patients with prior cervical spinal cord injury resulting in quadriplegia were evaluated with magnetic resonance imaging (MRI) long after their initial injury, either because of the relatively recent onset of new and worsening neurologic symptoms or to rule our residual compression on the spinal cord or nerve roots. The results of MRI were compared with delayed metrizamide computed tomography (CT) in 10 cases, and in five of those the results were also compared with intraoperative spinal sonography. It was found that MRI more accurately demonstrated the intramedullary abnormalities in the injured spinal cord than did delayed metrizamide CT because the former could separate myelomalacia from a posttraumatic spinal cord cyst, a differentiation that was frequently difficult with delayed metrizamide CT. T2-weighted spin-echo pulsing sequences with long echo times were particularly useful in evaluating these patients.

Post-traumatic spinal-cord cyst. A case report.

Post-traumatic spinal-cord cyst. A case report.

Post-traumatic spinal-cord cyst. A case report.

Post-traumatic spinal-cord cyst. A case report.

Intraoperative spinal sonography: adjunct to metrizamide CT in the assessment and surgical decompression of posttraumatic spinal cord cysts

Ten patients with prior spinal cord trauma were examined preoperatively by metrizamide computed tomography (CT) and were studied subsequently by intraoperative spinal sonography. On comparing intraoperative sonography with metrizamide CT, it was found that metrizamide CT tends to overestimate the size and number of posttraumatic cysts, that areas of myelomalacia on metrizamide CT correspond to areas of abnormal echogenicity on intraoperative sonography, and that intracyst septations are seen only on intraoperative sonography. By monitoring the position of the shunting catheter during surgery, intraoperative sonography can assure its proper intramedullary placement and demonstrate the successful decompression of the cyst. If no cyst is found with intraoperative sonography, further surgery is obviated. Intraoperative sonography is recommended for all cases where decompression of cord cysts is planned.

Posttraumatic spinal cord cysts: clinical features and characterization with metrizamide computed tomography.

Sixteen patients with posttraumatic spinal cord cysts (PTSCC) were evaluated clinically and studied with metrizamide computed tomography (MCT). These patients presented months to years following a severe spinal cord injury, usually with new or progressively worsening neurological symptoms. The development of the PTSCC was unrelated to the location, type, and severity of injury, or to the time interval from the original injury. MCT showed that these cysts occur most frequently in normal or atrophic cords, they may be multiple, they most frequently are found in the dorsal portion of the cord, and they may vary along their length in width and position within the cord. Knowledge of this radiographic morphology is crucial to the surgical planning. The location of the cysts and the mode of their enlargement are correlated with anatomic features of the spinal cord and changes in cerebrospinal fluid dynamics. Cyst-to-subarachnoid space shunting relieves the majority of symptoms.