Spinal Stability Research Articles

Outcomes of 12 Weeks of Schroth and Asymmetric Spinal Stabilization Exercises on Cobb Angle, Angle of Trunk Rotation, and Quality of Life in Adolescent Boys with Idiopathic Scoliosis: A Randomized-controlled Trial.

The available evidence on the efficiency of well-known Schroth's exercises (SE) for correcting adolescent idiopathic scoliosis (AIS) is limited, especially in combination with the asymmetric spinal stabilization exercises (ASSE) method. Therefore, we hypothesized that, first, there is no difference in the efficiency of the combined exercises (SE+ASSE) and SE alone in improving Cobb angle, angle of trunk rotation (ATR), and quality of life (QoL) in AIS. Second, there is no difference in the efficiency of SE and no intervention on corresponding variables in treating AIS. This randomized controlled trial (RCT) consisted of 40 patients with mild AIS (10-18-year-old boys) divided into three groups: SE (n=15), SE+ASSE (n=15), and a waitlist control group (n=10). For 12 weeks (three days a week), both experimental groups performed SE, the combined group additionally received ASSE, and the control group received no intervention. The assessment included Cobb angle (photogrammetry), ATR (Adam's test), and QoL (Scoliosis Research Society-22 questionnaire). It was found that Cobb angle, ATR, and QoL improved significantly in the combined SE+ASSE group (Cobb=16.45° to 9.01°; ATR=4.93° to 1.33°) compared to the SE group (P<.001). In addition, the SE group showed significant amelioration in the mentioned variables (Cobb=15.09° to 9.77°; ATR=4.23° to 2.17°) compared to the control group (P<.001), whereas the control group remained almost unchanged. Based on the obtained results, the combination of SE and ASSE provided more benefits than SE alone, and the SE results were efficient compared to the no-intervention group regarding the correction of scoliosis and related problems. However, patients with moderate to severe scoliosis should also be investigated in longer treatment periods in future.

Development of a smart implant for monitoring spinal stabilization using a rod-integrated measurement system

Development of a smart implant for monitoring spinal stabilization using a rod-integrated measurement system

Thoracolumbar Burst Fracture Treatment Using Posterior Pedicle Screw Fixation and Autogenous Bulk Iliac Bone Graft Fusion

Background: Thoracolumbar vertebral fracture is the most common type of thoracolumbar vertebral fracture. For the patients with severe thoracolumbar vertebral burst fracture and neurological impairment, surgical decompression and reconstruction of spinal stability is an important intervention method, however, there is still controversy on the way of postoperative stability reconstruction. Objective: This study was to investigate the efffcacy of posterior open reduction, pedicle screw ffxation, and autogenous iliac bone graft fusion in the treatment of thoracolumbar burst fractures with neurological impairment. Methods: The clinical data of 43 patients with thoracolumbar single vertebral burst fracture with neurological function injury treated in our department from January 2016 to December 2020 were retrospectively analyzed. The Visual Analog Scale (VAS) score of lumbothoracic pain, the occupying rate of spinal canal, the ratio of the anterior height of the injured vertebral body to the normal height, Cobb angle, and the American Spinal Injury Association (ASIA) classiffcation of neurological function were compared before and after operation. All patients completed the procedure successfully. Results: Bone graft fusion was achieved in all patients, and no screw or rod was broken. The VAS score of thoracolumbar pain, the ratio of the anterior height of the injured vertebral body to the normal height, and the Cobb angle were signiffcantly lower than those before operation at 1 and 12 months after operation (P &lt; 0.001). There was no signiffcant difference in the VAS score of thoracolumbar pain, the ratio of the anterior height of the injured vertebral body to the normal height, and the Cobb angle between 1 and 12 months after operation. The occupying rate of spinal canal 6 months after operation was lower than that before operation (12.02% ±7.35% vs. 46.98% ±9.26%), and the difference was statistically signiffcant (t = 20.066, P &lt; 0.05). There was a signiffcant difference in ASIA classiffcation of neurological function between 12 months after operation and before operation (Z = −5.372, P &lt; 0.001). The neurological function was signiffcantly improved 12 months after operation. Conclusion: Reconstruction of vertebral lamina with iliac bone graft is an effective method for the treatment of thoracolumbar burst fractures, which can reduce the loss of vertebral height and recurrent kyphosis and avoid the neurological impairment caused by secondary spinal stenosis.

Advances in implants and bone graft types for lumbar spinal fusion surgery.

The increasing prevalence of spinal disorders worldwide necessitates advanced treatments, particularly interbody fusion for severe cases that are unresponsive to non-surgical interventions. This procedure, especially 360° lumbar interbody fusion, employs an interbody cage, pedicle screw-and-rod instrumentation, and autologous bone graft (ABG) to enhance spinal stability and promote fusion. Despite significant advancements, a persistent 10% incidence of non-union continues to result in compromised patient outcomes and escalated healthcare costs. Innovations in lumbar stabilisation seek to mimic the properties of natural bone, with evolving implant materials like titanium (Ti) and polyetheretherketone (PEEK) and their composites offering new prospects. Additionally, biomimetic cages featuring precisely engineered porosities and interconnectivity have gained traction, as they enhance osteogenic differentiation, support osteogenesis, and alleviate stress-shielding. However, the limitations of ABG, such as harvesting morbidities and limited fusion capacity, have spurred the exploration of sophisticated solutions involving advanced bone graft substitutes. Currently, demineralised bone matrix and ceramics are in clinical use, forming the basis for future investigations into novel bone graft substitutes. Bioglass, a promising newcomer, is under investigation despite its observed rapid absorption and the potential for foreign body reactions in preclinical studies. Its clinical applicability remains under scrutiny, with ongoing research addressing challenges related to burst release and appropriate dosing. Conversely, the well-documented favourable osteogenic potential of growth factors remains encouraging, with current efforts focused on modulating their release dynamics to minimise complications. In this evidence-based narrative review, we provide a comprehensive overview of the evolving landscape of non-degradable spinal implants and bone graft substitutes, emphasising their applications in lumbar spinal fusion surgery. We highlight the necessity for continued research to improve clinical outcomes and enhance patient well-being.

Surgical Outcome of Occipitocervical Fixation for Craniocervical Instability

OBJECTIVES To evaluate the efficacy of Occipitocervical Fixation (OCF) in patients with craniocervical instability in two tertiary care hospitals. METHODOLOGY This retrospective case series study was conducted at Hayatabad Medical Complex, Peshawar, from April 2017 to December 2020. A non-probability sampling technique was used, and size was calculated via online software with a 95 % confidence level and 5% margin of error. All patients with craniocervical instability were included in our study, and those having occipital bone fractures or previously operated patients with the same technique were excluded from the study. The Nurick score was used to assess neurological function pre-and postoperatively. The demographic details of the patients, clinical features, radiographic findings (pre- and postoperative), and clinical outcomes using the Nurick myelopathy grading system were noted and entered into a structured proforma. All data were entered into SPSS Version 18 and analyzed. The results were presented in tables and pictures. RESULTSA total of 26 cases with craniocervical instability underwent OCF. The mean age of the patients was 40.5 + 1.2 SD years. There were 10 male patients and 16 female patients. The majority of patients showed improvements in myelopathic symptoms after the operation. The mean preoperative Nurick score was 3.0. At the end of follow-up after surgery, the mean Nurick score was 2.1. There was a total of 7(14.28%) cases having complications, of which 4 (8.16%) patients had wound infection, 2 (4.08%) patients had implant failure, and 1(2.04%) had vertebral artery injury. However, no postoperative neurological deficit was observed. CONCLUSION Occipitocervical fixation is a reasonable option to have spinal stability, achieve bone fusion and get neurological improvement. Certain conditions complicate the procedure, but experienced hands can safely handle these.

Commentary on relevant issues in surgical treatment of spinal metastatic tumors

The multidisciplinary treatment model led by surgery has become a comprehensive strategy and overall concept for the treatment of spinal metastatic tumors. But the surgical treatment of spinal metastatic tumors is different from primary malignant tumors of the spine. Surgery is only a part of the multidisciplinary comprehensive treatment. Therefore, the following aspects need to be evaluated comprehensively based on the survival assessment, evaluation of spinal stability damage, nerve dysfunction, and oncological characteristics of the metastatic tumors with a reasonable surgical intervention. The attention should be paid to the minimally invasive treatment of spinal metastases, progress of new radiotherapy technology, neoadjuvant chemotherapy, targeted drug therapy and other medical treatment to make a comprehensive and individualization decision which is benefit to relieve patients ' pain, reconstruct spinal stability and avoid paralysis. While improving patient survival, increasing local tumor control rate and possibly prolonging survival time, avoiding excessive surgery as much as possible.

Comparative evaluation of different spinal stability metrics

Direct in vivo measurements of spinal stability are not possible, leaving computational estimations (such as dynamic time series and structural analyses) as the feasible option. However, differences between different stability assessment approaches and metrics remain unclear. To explore this, we asked 32 participants to perform 35 cycles of repetitive lifts with and without load (4/2.6 kg for males/females). EMG signals and 3D kinematics were collected via 12 surface electrodes and 17 inertial sensors, and three dynamical stability measures were computed: short and long temporal and conventional maximum Lyapunov exponents (LyE) and maximum Floquet multipliers (FM). A dynamic subject-specific EMG-assisted musculoskeletal model computed four structural stability measures (critical muscle stiffness coefficient at which spine becomes unstable, average spine stiffness, minimum and geometric average of Hessian matrix eigenvalues). Across cycles, dynamical and structural stability outcomes varied noticeably. Temporal short-term LyE and all structural stability measures were more influenced by the cycle percentage (posture factor) than by phase (lifting, lowering) or load factor. The effect of all factors were non-significant for FM and long LyE, except for the posture on LyE-L with a small effect size. Pearson's correlations revealed a weak to moderate, or non-existent, correlation between structural and dynamical stability metrics, with small shared variances, underscoring their distinct and independent nature and theoretical foundations. Moreover, the low sensitivity of dynamic measures to posture and load factors, found in this study, calls for further examination. Considering the limitations and shortcomings of both dynamical and structural stability assessment approaches, there is a need for the development of improved musculoskeletal stability evaluation techniques.

Biomechanical analysis of the door-shaped titanium plate in single-level anterior cervical discectomy and fusion

BackgroundAnalyse and discuss the immediate stability of the cervical spine after anterior cervical discectomy and fusion using a door-shaped titanium plate and compare it with the traditional titanium plate, to provide biomechanical evidence for the rationality and effectiveness of the door-shaped titanium plate in clinical applications.MethodsTen adult goat C4/5 vertebral bodies were obtained, and models were prepared using denture base resin. Biomechanical experiments were performed on the specimens before internal fixation. MTS was used to conduct non-destructive biomechanical loading tests in six directions, including flexion, extension, left–right bending, and left–right torsion, recording the range of motion (ROM) and neutral zone (NZ) of each specimen. The specimens were then randomly divided into two groups: the study group was fixed with a door-shaped titanium plate, and the control group was fixed with a traditional titanium plate. ROM and NZ in each direction were measured again. After measurements, both groups were subjected to 0.5 Hz torsion loading with a torque of 2 N m for a total of 3000 cycles, followed by measuring ROM and NZ in six directions once more.ResultsCompared to before fixation, ROM and NZ in both groups significantly decreased in all six directions after fixation, with statistical significance (P < 0.05); after fixation, the study group showed slightly lower values for various mechanical reference parameters compared to the control group, with no statistical significance (P > 0.05); after 3000 torsional loads, both internal fixation groups showed increased ROM and NZ compared to after fixation but to a lower extent, and no screw or titanium plate loosening was observed. Compared to before fixation, the differences were still statistically significant (P < 0.05), with the study group having slightly lower ROM and NZ values in all directions compared to the control group, with no statistical significance (P > 0.05).ConclusionThe door-shaped titanium plate exhibits mechanical properties similar to the traditional titanium plate in all directions, and its smaller size and simpler surgical operation can be used for anterior cervical endoscopic surgery, reducing surgical trauma. It is clinically feasible and deserves further research and promotion.

Finite element mechanical analysis of ipsilateral approach and contralateral approach in unilateral bilateral endoscopic spine surgery

BackgroundUnilateral bilateral endoscopic spine surgery (UBE) is often performed to treat lumbar spinal stenosis and disc herniation. It has become a prominent method in endoscopic spine surgery because of its very low learning curve and broader operative field of vision. Currently, the ipsilateral approach and contralateral approach have been established for disc herniation in the foraminal area, intervertebral foramen region, or pedicle region. The contralateral method offers many benefits over the ipsilateral approach, including less bone labour during microsurgical decompression and the preservation of facet joints. However, because it uses the interlaminar window approach, it inevitably involves osteotomy of the patient’s superior and inferior articular processes, which may result in corresponding deterioration in the spine’s biomechanical stability and subsequent adjacent facet joint diseases caused by facet joint degeneration postoperatively.ObjectiveAs a result, the purpose of this work is to use a finite element model to evaluate how the ipsilateral approach and contralateral approach in unilateral bilateral endoscopic spine surgery affect spinal stability while treating identical intervertebral disc herniation.Study designIn this study, a three-dimensional lumbar-sacral spine model was built and verified. Osteotomies were conducted for armpit-type lumbar disc herniation (LDH), periradicular-type LDH, and shoulder-type LDH. Postoperative lumbar spine models of the ipsilateral approach and contralateral approach in unilateral bilateral endoscopic spine surgery were developed. The von Mises stress on the endplate, shear force on the annulus fibrosus, pressure inside the intervertebral disc, and range of motion (ROM) of the L3 segment were all determined. The results of our well-validated model showed that osteotomy done in the ipsilateral approach deteriorated most biomechanical metrics.ResultsIn the majority of loading conditions, the contralateral approach caused the intervertebral disc’s biomechanical properties to increase, and the ipsilateral approach caused the intervertebral disc’s biomechanical properties to increase sharply more than the contralateral approach.ConclusionThe contralateral approach, which is now extensively employed in unilateral bilateral endoscopic spine surgery, may be regarded as an ideal surgical alternative for treating lumbar disc herniation without producing iatrogenic instability. This approach has a low facet joint reduction rate, minimum soft tissue injury, and precisely identifies the midline of the central spinal canal during the retraction of the thecal sac and nerve roots.

Radiation doses to patients during pedicle screw fixation of the spine

Objective. To analyze the radiation doses to patients during spinal decompression and stabilization surgery under optical CT navigation and fluoroscopy.Material and Methods. Study design: retrospective cohort study. The sample consisted of 164 patients who underwent transpedicular fixation of the spine performed by percutaneous or open techniques. In the O-arm group (n = 109), cone-beam CT combined with optical navigation was used; in the C-arm group, fluoroscopy (n = 55) was used. The effective dose equivalent (EDE) and the maximum absorbed dose (MAD) in the skin were evaluated.Results. EDE in the O-arm group was Me 9.1 mSv, [IQR: 7.1–11.6], and in the C-arm group –Me 1.8 mSv [IQR: 1.8–5.6], p &lt; 0.0001. Maximum absorbed dose in the skin in the O-arm group was Me 49.3 mGy [IQR: 27.0–96.9], and in the C-arm group – Me 36.1 mGy [IQR: 16.6–111.5], p = 0.424.Conclusion. The use of CT navigation and fluoroscopy during pedicle screw fixation of the spine is not associated with the risk of developing deterministic effects. The use of intraoperative CT navigation during pedicle screw fixation is associated with a greater patient EDE compared with that of fluoroscopy (p &lt; 0.05). Differences in EDE received by patients undergoing open and percutaneous techniques of pedicle screw fixation are statistically insignificant, regardless of the type of beam guidance and the number of fixation levels. The number of intraoperative CT scans is proportional to the patient EDE (p = 0.018).

Huge extradural multilevel lumbar abscess

Extensive spinal epidural abscesses (ESEAs), occupying three or more spinal regions, are rare forms of vertebral infection. Multilevel laminectomy in these cases is controversial because of the risk of vertebral instability. We report the case of a 47-year-old patient known with ureterohydronephrosis 2nd degree, admitted for severe vertebral pain (VAS 8/10) from 2 months, paraparesis (ASIA 1/5 left, 4/5 right, retention of urine and faeces) from three days. The analysis discovered Diabetes Mellitus type 2, and high levels of inflammatory tests. CT and MRI of the vertebral area with contrast revealed dorsal compression of the spinal cord and cauda equina by an epidural abscess extending from L1-L5, bilateral in the soft adjacent paravertebral tissues especially psoas muscles but sparing the intervertebral discs. Surgical treatment: alternate fenestrations L1-L5, more important on the left side. By this technique, we removed the fluid pus and also granulomatous pus from posterior epidural space L1-L5, bilateral medial foramina, interspinous and supraspinous space, and psoas muscles. The identified germ was Staphylococcus aureus ++++. Postoperatively, we used a continuous drainage washing system with Vancomicyne and diluted Betadine—a course of six-week Vancomycin 2 grams/day iv. The drainage system was blocked after 24 hours and we had to remove it and all the wires of the suture. We had to dress up every day for the surgical field and wash deep inside the field with diluted betadine for 3 weeks till the surgical field was completely cured. After 3 months postoperatively the patient was cured radiologically and clinically. Follow up 18 months. Conclusion: alternate fenestration has the advantages of removing liquid and granulomatous pus in the epidural posterior area and preserving the spine stability.

A positive allosteric modulator of TRPC6 promotes neuroprotective effects &lt;i&gt; in vitro &lt;/i&gt;

Alzheimer’s disease is a neurodegenerative disorder and the primary cause of dementia among elderly individuals. Unfortunately, there is no known cure for Alzheimer’s disease. Recently, a TRPC6-mediated intracellular signaling pathway was discovered, which plays a vital role in memory formation by regulating dendritic spine stability. Knockdown of TRPC6 expression was found to prevent store-operated calcium entry. The overexpression of TRPC6 or its pharmacological activation restores store-operated calcium entry in hippocampal neurons affected by Alzheimer’s disease [1, 2]. TRPC6 overexpression rescues mushroom spine loss in presenilin and APP knock-in mouse models of Alzheimer’s disease [1] and protects neurons from ischemic brain damage. Mice that overexpress TRPC6 in the brain exhibit improved cognitive function and increased excitatory synapse formation. These findings propose TRPC6 as a promising molecular target for the treatment of synaptic deficiency. We recently demonstrated that compound 51164 (N-(2-chlorophenyl)-2-(4-phenylpiperazine-1-yl) acetamide), a piperazine derivative, enhances TRPC6 channels and induces an upregulation of postsynaptic neuronal store-operated calcium entry. Furthermore, it increases mushroom spine percentage and recovers synaptic plasticity in mouse models of Alzheimer’s disease that have an amyloidogenic nature [2]. However, additional investigations of 51164 have demonstrated that the compound is unstable in plasma and cannot penetrate the blood-brain barrier (unpublished data). As such, the aim of this study is to discover a new piperazine derivative that functions as a positive modulator for TRPC6-specific and showcases neuroprotective qualities. In this study, we present in silico and in vitro investigations of a novel TRPC6 specific modulator. Based on our in silico research, we narrowed down the selection to 14 compounds through the piperazine derivative 51164 that met all drug-lead likeness criteria and showed a high affinity for the active center of TRPC6. Calcium imaging technique was usedto establish that the compound z12_30 triggered the activation of TRPC6 but not the structurally linked TRPC3 channel. In addition, a molecular dynamics approach revealed that z12_30 forms a stable complex with the TRPC6 active site. As a result, z12_30 was selected as the lead compound for further investigation. Studies showed that z12_30 safeguards hippocampal mushroom spines from amyloid toxicity in vitro and effectively restores synaptic plasticity in brain slices from aged 5xFAD mice. Preclinical trials demonstrate that z12_30 remains stable in both human and mouse plasma samples. We suggest that z12_30 is a promising prototype of a TRPC6-selective drug suitable for treating synaptic deficiency in hippocampal neurons affected by Alzheimer’s disease.

Comparing the Efficacy of Dynamic Neuromuscular Stabilization Exercises and Kegel Exercises on Stress Urinary Incontinence in Women: A Pilot Study.

Background and objective Stress urinary incontinence (SUI) is a prevalent condition affecting women of various age groups, significantly impacting their quality of life. To address this multifaceted issue, a comprehensive approach that goes beyond traditional pelvic floor exercises is needed. Dynamic neuromuscular stabilization (DNS) exercises, targeting the integrated spinal stabilization system, offera promising alternative. Thus, this study aimed to compare the effectiveness of DNS exercises and Kegel exercises in managing SUI among women. Methods This single-blinded, pilot study involved 24 women aged 18-40 years with mild to moderate SUI. Participants were divided into DNS and Kegel exercise groups. Outcome measures included perineometer readings, electromyography (EMG) data, and the Urogenital Distress Inventory-6 (UDI-6). Statistical analysis compared baseline and 12-week data within and between groups, and rank-biserial correlation coefficient (r) as a measure of effect size in our study wascalculated. Results At 12 weeks, the DNS group showed significant improvement in pelvic floor muscle strength compared to Kegel exercises (p = 0.005). Both groups had significantly enhanced pelvic floor muscle strength (p < 0.05). A significant change occurred for EMG average, EMG peak, and EMG maximum voluntary contraction (MVC) at 12 weeks (average p = 0.005; peak p = 0.001; MVC p = 0.009), with significant improvements in both groups (p < 0.05). For UDI-6, a significant difference emerged between the two groups at 12 weeks (p < 0.05), with significant improvements in both groups individually from baseline to 12 weeks (p < 0.05). The effect size "r" for all variables indicated a medium to large effect size, underscoring the substantial and significant impact of DNS exercises in managing SUI among women compared to Kegel exercises. Conclusion This study suggests that DNS exercises, emphasizing the coordinated activation of the diaphragm, abdominals, multifidus, and pelvic floor, may provide a more effective approach for managing SUI in women compared to traditional Kegel exercises.

Clinical &amp; Radiological Outcomes of Posterior Decompression &amp; Transforaminal Lumbar Interbody Fusion (TLIF) among Patients with Lumbar Spondylolisthesis – A Prospective Study

Introduction: Lumbar spondylolisthesis, a condition characterized by the displacement of one vertebra over another, often leads to chronic back pain and functional impairment. Posterior decompression and TLIF are used as surgical options for patients with lumbar spondylolisthesis. Aim of the Study: The aim of this study was to assess the clinical &amp; radiological outcomes of posterior decompression &amp; transforaminal lumbar interbody fusion (TLIF) among patients with lumbar spondylolisthesis. Methods: This prospective observational study was carried out at NITOR, Dhaka, Bangladesh, during the period from January 2020 to December 2021. Total 30 patients with degenerative lumbar spondylolisthesis were included in this study. Result: In this study, majority of participants were aged 41-50 (47%), predominantly female (60%). Clinical outcomes showed significant improvements post-treatment: low back pain and leg pain, measured by VAS, decreased substantially, and disability scores (ODI and Roland-Morris) also improved markedly. Quality of life, assessed by SF-36, showed notable enhancements in both physical and mental scores. Radiologically, there were significant improvements in disc and foraminal height, reduction in spondylolisthesis severity, and restoration of lumbar lordosis and spinal stability. The average surgery time was around 147.5 minutes, with a mean blood loss of 382.7 mL and an average hospital stay of 7.1 days. A 90% fusion rate was achieved at 1-year follow-up, with dural tears being the most common complication. Despite some complications, the majority of surgeries were completed safely. Conclusion: Posterior decompression and TLIF appear to be effective in treating lumbar spondylolisthesis, as evidenced by improved clinical and radiological outcomes.

Surgical Treatments and Long-Term Outcomes for Pediatric Patients With Lumbar Spinal Tumors.

Retrospective case‒control study. This study aimed to report the effects of surgical intervention on spinal stability recovery and to assess the long-term outcomes of children and adolescents with lumbar tumors. From January 2016 to June 2021, 42 pediatric patients with lumbar tumors were selected and separated into different groups based on the surgical method used (total en bloc resection (TER) group, n = 21; piecemeal resection (PR) group, n = 21; titanium mesh (TM) group n = 23; artificial vertebrae (AV) group n = 19). The clinicopathological characteristics, treatments and related outcomes were described in detail and compared between groups, with P value ≤.05 indicating statistically significant differences. The average follow-up duration was 24.89 months, and the mean age was 14.89 ± 2.41years. There were no significant differences in the mean operation time, average blood loss, complication rate, or length of hospital stay between the groups. The ODI, VAS and JOA scores at the final follow-up (FF) were elevated after surgery in all groups. The FF local angular drift (LOD) and lumbar angular drift (LUD) were greater in the TM group than in the AV group (P = .03, P = .001). After surgery, pediatric patients with lumbar tumors can obtain satisfactory spinal stability, effective relief of pain symptoms and substantial improvements in neurological function. There was no significant difference in the invasiveness, safety or timeliness between the 2 surgical methods, so TER is recommended due to its low postoperative recurrence rate and good local control. Spinal fusion in the AV group resulted in better spinal stability.

Do upright radiograph findings affect treatment plans for patients with thoracic and lumbar spine injuries?

Background After spinal trauma, upright radiographs are commonly used to evaluate spinal stability. However, the benefits and risks of upright films have not yet been thoroughly studied. This study aimed to elucidate the effect that upright imaging has on patients with thoracic and/or lumbar spinal injuries by evaluating the impact on treatment decisions. Methods A retrospective review of all adult patients who suffered traumatic spine injuries and received thoracic and/or lumbar spine imaging between April 2019 and March 2021 in a Level 1 University Trauma Center. Patients’ charts were reviewed, and those patients who received upright films as a final dynamic evaluation of their spine before clearance for standing were identified. Fractures due to infection or malignancy were excluded as were 17 patients who only received post-operative upright films. We examined whether upright films modified the treatment strategy. Results Of the 353 upright radiographs conducted on patients without prior surgical intervention, 27 (7.6%) of these studies provided information not known from prior imaging; the remaining 92.4% of upright films were considered “unchanged” or “stable.” Of the 27 patients who had changes in uprights, in only 7 cases (2.0%) did the new findings affect the treatment plans. In 6/7 cases, upright films showed increased vertebral body height loss and/or worsening fractures—suggestive of instability—in previously known T12-L1 fractures. Conclusions We studied 353 patients who received T and/or L uprights after suffering a traumatic spine injury and before receiving any surgical interventions. Of these patients, 98.0% did not gain substantial benefit from the additional imaging as the upright radiographs did not affect the treatment strategy. In 2% of cases a significant change in management was indicated following the upright films; virtually all of these were in T11-L2 fractures. The utility of upright films should be re-evaluated and more studies directed to potentially clarify which subgroups of patients will benefit from these radiographs.

Optimizing Spinal Fusion in Degenerated Spinal Stenosis, proposing a hybrid scoring system for Bangladesh people in law Sack pain

Background: Degeneration is a progressive phenomenon in lumbar spinal stenosis patients. The outcome of surgery predictors is sometimes biased. Fusion and stabilization in such cases are unnecessary in many situations. There is still a debate to decompress only versus fusion in low-grade listhesis. Fusion and stabilization in the aged lumbar spine should have clear indications. Objective: To assess whether the fusion is necessary in lumbar spinal stenosis in selected cases or not and to create a new scoring system among the patients of low backache in Bangladeshi people. Method: A total of 120 cases were observed retrospectively from 2012 to 2018 in Comfort Hospital, Dhaka, Bangladesh. And 40 more cases data will be collected in the upcoming study period of 6 months. To assess the study we will conduct a survey. In previous cases, the patients had undergone three types of surgeries (Laminectomy, Unilateral approach, and Fusion surgeries). ODI and Swiss score were used for assessment of functional outcome. A new scoring system has been made for patients who may be benefited from fusion or non- fusion surgeries. Results: In retrospective data, there were 80 male and 40 female patients. Maximum patients were between 41 to 50 years. 59.17% were heavy workers and 66.67% were smoker. Maximum patients (59.17%) had undergone unilateral surgical approaches and 18.33% undergone fusion surgeries. 98.33% patients had satisfactory outcome in our study. In our hybrid scale, the pain status showed, 52.50% had moderate pain, 22.50% had mild pain, 20% had severe pain and only 5% had very severe pain. Maximum participants having low back pain were below 30 years old and 65% lift weight more than 25 kg. The total pain score was significant in our correlation test. The Cronbach's Alpha (.784) was significant in Bangladeshi socio- demographic population. Conclusion: The outcome of such a study will help to know either fusion surgeries in selected cases are effective for lumbar spinal stenosis or not. Also, it will probably help to select patients for such a study and to improve surgical treatment methods. Bangladesh Med Res Counc Bull 2023; 49: 164-170

Novel Bace 1 selective inhibitor does not affect dendritic spine plasticity

AbstractBackgroundAll clinical BACE‐inhibitor trials for the treatment of Alzheimer´s Disease have failed due to insufficient efficacy or side effects like worsening of cognitive symptoms. The latter could have been the result of the inhibition of BACE at the synapse where it is expressed in high amounts. We have previously shown that prolonged inhibition of BACE interferes with structural and functional synaptic plasticity (Filser et al. Biol. Psych 2015, Blume et al. Front. Aging Neurosci. 2018), most likely due to the diminished processing of the physiological BACE substrate Seizure protein 6 (Sez6, Zhu et al. Biol. Psych. 2018), which is exclusively processed by BACE1 and it is required for dendritic spine plasticity. The aim of the current study was to elucidate the effects of selective BACE1 inhibitors on dendritic spine plasticity at a dose that affects Sez6 cleavage to various degrees but not completely.MethodBy using longitudinal in vivo two‐photon microscopy, we investigated the effect on dendritic spine dynamics of pyramidal layer V neurons in the somatosensory cortex in mice treated with 2 novel highly selective BACE1 inhibitors developed at Shionogi in comparison to Elenbecestat which reduce soluble Sez6 to 27% (Elenbecastat), 17% (Shionogi Compound 1) and 39% (Shionogi Compound2) of baseline levels in untreated animals. For the detection of the soluble Sez6 ectodomain, the BACE cleavage product from full‐length Sez6, Western blot analysis was performed using a highly specific Sez6 antibody generated in the lab of Stefan Lichtenthaler (Pigoni et al. Mol. Neurodeg. 2016).ResultWe observed that BACE1 selective inhibitors do not alter dendritic spine density and plasticity in cortical neurons if at least 27% of soluble Sez6 remains. In detail, the density of gained and lost spines does not change under the treatment with Shionogi Compound 2 or Elenbecastat. Also, no differences in the stability of dendritic spines were found during treatment with these two compounds. With Compound 1 however, a significant spine loss occurs after 21 days of treatment.ConclusionSelective BACE1 inhibitors do not alter dendritic spine plasticity in mice if dosing reduces synaptic BACE1 cleavage of Sez6 not below 27% of baseline soluble Sez6 levels. BACE1 selective inhibitors may be potential novel candidates for clinical trials treating AD if dosing is carefully adjusted to the amount of Sez6 cleavage, which can be easily monitored during the first weeks of treatment.

Comparative evaluation of multi-fold rib and structural iliac bone grafts in single-segment thoracic and thoracolumbar spinal tuberculosis: clinical and radiological outcomes

ObjectiveTo compare clinical and radiological outcomes of multi-fold rib and structural iliac bone grafts, the primary autologous graft techniques in anterolateral-only surgery for single-segment thoracic and thoracolumbar spinal tuberculosis.MethodsThis retrospective study included 99 patients treated from January 2014 to March 2022, categorized into 64 with multi-fold rib grafts (group A) and 35 with structural iliac bone grafts (group B). Outcomes assessed included hospital stay, operation time, intraoperative blood loss, postoperative drainage, complications, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), the Visual Analog Scale (VAS) for pain, the Oswestry Disability Index (ODI), bone fusion time, and the American Spinal Injury Association (ASIA) impairment scale grade. Segmental kyphotic angle and intervertebral height were measured radiologically before surgery and follow-up.ResultsThe mean follow-up was 63.50 ± 26.05 months for group A and 64.97 ± 26.43 months for group B (P > 0.05). All patients had achieved a clinical cure. Group A had a shorter operation time (P = 0.004). Within one week post-surgery, group B reported higher VAS scores (P < 0.0001). Neurological performance and quality of life significantly improved in both groups. No significant differences were observed in segmental kyphotic angle and intervertebral height between the groups pre- and postoperatively (P > 0.05). However, group A showed a greater segmental kyphotic angle at the final follow-up, while group B had better maintenance of kyphotic angle correction and intervertebral height (P < 0.05). Bone fusion was achieved in all patients without differences in fusion time (P > 0.05).ConclusionsMulti-fold rib grafts resulted in shorter operation times and less postoperative pain, while structural iliac bone grafts provided better long-term maintenance of spinal alignment and stability, suggesting their use in cases where long-term outcomes are critical.

Genetic context controls microglia‐induced neuronal damage in Alzheimer’s disease

AbstractBackgroundThe activation of microglia and the loss of synapses have emerged as key events in Alzheimer’s disease (AD) progression, yet the relationship between these processes is not clear. Previous studies suggest genetic variation controls microglial activation in AD mouse models, so we evaluated how the elimination of brain microglia influenced synapses on hippocampal pyramidal cells across two genetically distinct AD mouse models.MethodUsing a viral approach, we labeled hippocampal neurons that project to the frontal cortex by expressing GFP in young (3m) inbred C57BL/6J and genetically distinct PWK/PhJ female mice with or without a transgenic (APP/PS1) allele that drives amyloid pathology. At 4m we placed half of the mice on diet formulated with CSF1R inhibitor PLX5622 to deplete brain microglia. At 8m, a time when plaque pathology is present in transgenic mice, we examined cognition using the delayed spatial task. We then analyzed the density and morphology of spines across multiple dendritic domains, as well as amyloid plaques and markers of disease‐associated (DAM) and interferon responding (IRM) states of IBA1+ microglia.ResultWhile spatial cognition was unaffected by PLX5622, we identified B6.APP/PS1 as susceptible and PWK.APP/PS1 as resilient to cognitive deficits at 8m. Across both strains, PLX5622 depleted hippocampal microglia but did not affect amyloid plaques. In contrast, we observed strain differences in spine synapse density and morphology. Compared to spine stability across PWK wild‐type (WT) and APP/PS1 mice, we measured increased density of small spines in B6.APP/PS1 mice (compared to WT). B6.APP/PS1 mice showed reduced spine density with PLX5622, whereas PWK.APP/PS1 mice remained unaltered. These changes in spine density corresponded to DAM being resistant to depletion with PLX5622 in APP/PS1 mice (especially B6), whereas IRM were susceptible, suggesting a neuroprotective role for IRM.ConclusionWe show here that genetic context determines how synapses on CA1 projection neurons respond to the depletion of brain microglia and AD transgenes. Since PWK.APP/PS1 are resistant to hippocampal neuronal damage with robust microglia activation, this strain can be leveraged to further study mechanisms of resilience to AD cognitive deficits and neuropathological damage that can be harnessed for better AD therapeutic treatments.