Some studies have suggested that early surgical treatment can effectively improve the prognosis of cervical spinal cord injury without radiological abnormality, but no research has focused on the development of a prog...Some studies have suggested that early surgical treatment can effectively improve the prognosis of cervical spinal cord injury without radiological abnormality, but no research has focused on the development of a prognostic model of cervical spinal cord injury without radiological abnormality. This retrospective analysis included 43 patients with cervical spinal cord injury without radiological abnormality. Seven potential factors were assessed: age, sex, external force strength causing damage, duration of disease, degree of cervical spinal stenosis, Japanese Orthopaedic Association score, and physiological cervical curvature. A model was established using multiple binary logistic regression analysis. The model was evaluated by concordant profiling and the area under the receiver operating characteristic curve. Bootstrapping was used for internal validation. The prognostic model was as follows: logit(P) =-25.4545 + 21.2576 VALUE + 1.2160SCORE-3.4224 TIME, where VALUE refers to the Pavlov ratio indicating the extent of cervical spinal stenosis, SCORE refers to the Japanese Orthopaedic Association score(0–17) after the operation, and TIME refers to the disease duration(from injury to operation). The area under the receiver operating characteristic curve for all patients was 0.8941(95% confidence interval, 0.7930–0.9952). Three factors assessed in the predictive model were associated with patient outcomes: a great extent of cervical stenosis, a poor preoperative neurological status, and a long disease duration. These three factors could worsen patient outcomes. Moreover, the disease prognosis was considered good when logit(P) ≥-2.5105. Overall, the model displayed a certain clinical value. This study was approved by the Biomedical Ethics Committee of the Second Affiliated Hospital of Xi'an Jiaotong University, China(approval number: 2018063) on May 8, 2018.展开更多
Anesthesiologists work to prevent or minimize secondary injury of the nervous system and improve the outcome of medical procedures.To this end,anesthesiologists must have a thorough understanding of pathophysiology an...Anesthesiologists work to prevent or minimize secondary injury of the nervous system and improve the outcome of medical procedures.To this end,anesthesiologists must have a thorough understanding of pathophysiology and optimize their skills and equipment to make an anesthesia plan.Anesthesiologists should conduct careful physical examinations of patients and consider neuroprotection at preoperative interviews,consider cervical spinal cord movement and compression during airway management,and suggest awake fiberoptic bronchoscope intubation for stable patients and direct laryngoscopy with manual in-line immobilization in emergency situations.During induction,anesthesiologists should avoid hypotension and depolarizing muscle relaxants.Mean artery pressure should be maintained within 85–90 mmHg(1 mmHg = 0.133 kPa; vasoactive drug selection and fluid management).Normal arterial carbon dioxide pressure and normal blood glucose levels should be maintained.Intraoperative neurophysiological monitoring is a useful option.Anesthesiologists should be attentive to postoperative respiratory insufficiency(carefully considering postoperative extubation),thrombus,and infection.In conclusion,anesthesiologists should carefully plan the treatment of patients with acute cervical spinal cord injuries to protect the nervous system and improve patient outcome.展开更多
Decompression is the major therapeutic strategy for acute spinal cord injury,but there is some debate about the time window for decompression following spinal cord injury.An important goal and challenge in the treatme...Decompression is the major therapeutic strategy for acute spinal cord injury,but there is some debate about the time window for decompression following spinal cord injury.An important goal and challenge in the treatment of spinal cord injury is inhibiting or reversing secondary injury.Governor Vessel electroacupuncture can improve symptoms of spinal cord injury by inhibiting cell apoptosis and improving the microenvironment of the injured spinal cord.In this study,Governor Vessel electroacupuncture combined with decompression at different time points was used to treat acute spinal cord injury.The rat models were established by inserting a balloon catheter into the atlanto-occipital space.The upper cervical spinal cord was compressed for 12 or 48 hours prior to decompression.Electroacupuncture was conducted at the acupoints Dazhui(GV14) and Baihui(GV 20)(2 Hz,15 minutes) once a day for 14 consecutive days.Compared with decompression alone,hind limb motor function recovery was superior after decompression for 12 and 48 hours combined with electroacupuncture.However,the recovery of motor function was not significantly different at 14 days after treatment in rats receiving decompression for 12 hours.Platelet-activating factor levels and caspase-9 protein expression were significantly reduced in rats receiving electroacupuncture compared with decompression alone.These findings indicate that compared with decompression alone,Governor Vessel electroacupuncture combined with delayed decompression(48 hours) is more effective in the treatment of upper cervical spinal cord injury.Governor Vessel electroacupuncture combined with early decompression(12 hours) can accelerate the recovery of nerve movement in rats with upper cervical spinal cord injury.Nevertheless,further studies are necessary to confirm whether it is possible to obtain additional benefit compared with early decompression alone.展开更多
In previous studies,researchers have used singing to treat respiratory function in patients with spinal cord injury.However,few studies have examined the way in which vocal training affects respiratory neural plastici...In previous studies,researchers have used singing to treat respiratory function in patients with spinal cord injury.However,few studies have examined the way in which vocal training affects respiratory neural plasticity in patients with spinal cord injury.Vocal respiratory training(VRT)is a type of vocal muscle-related treatment that is often a component of music therapy(MT)and focuses on strengthening respiratory muscles and improving lung function.In this randomized controlled study,we analyzed the therapeutic effects of VRT on respiratory dysfunction at 3 months after cervical spinal cord injury.Of an initial group of 37 patients,26 completed the music therapy intervention,which comprised five 30-minute sessions per week for 12 weeks.The intervention group(n=13)received VRT training delivered by professional certified music therapists.The control group(n=13)received respiratory physical therapy delivered by professional physical therapists.Compared with the control group,we observed a substantial increase in respiratory function in the intervention group after the 12-week intervention.Further,the nerve fiber bundles in the respiratory center in the medulla exhibited a trend towards increased diversification,with an increased number,path length,thickness,and density of nerve fiber bundles.These findings provide strong evidence for the effect of music therapeutic VRT on neural plasticity.This study was approved by the Ethics Committee of China Rehabilitation Research Center(approval No.2020-013-1)on April 1,2020,and was registered with the Chinese Clinical Trial Registry(registration No.Chi CTR2000037871)on September 2,2020.展开更多
BACKGROUND Thoracolumbar fractures are generally combined with spinal cord injury to varying degrees,which may cause deterioration of the patients’condition and increase the difficulty of clinical treatment.At presen...BACKGROUND Thoracolumbar fractures are generally combined with spinal cord injury to varying degrees,which may cause deterioration of the patients’condition and increase the difficulty of clinical treatment.At present,anterior or combined anterior-posterior surgery is preferred for severe thoracolumbar fractures.AIM To investigate the effectiveness and postoperative rehabilitation of one-stage combined anterior-posterior surgery for severe thoracolumbar fractures with spinal cord injury.METHODS One-hundred-and-twenty patients who received surgery for severe thoracolumbar fractures with spinal cord injury at our hospital from February 2018 to February 2020 were randomly enrolled.They were randomly divided into group 1(one-stage combined anterior-posterior surgery,n=60)and group 2(onestage anterior-approach surgery,n=60).Treatment efficacy was compared between the two groups.RESULTS Blood loss was greater and the operation time was longer in group 1 than in group 2,and the differences were statistically significant(P<0.05).Incision length,intraoperative X-rays,and length of hospital stay were not significantly different between the two groups(P>0.05).Preoperative function of the affected vertebrae was not significantly different between the two groups(P>0.05).In each group,the patients showed significant improvement after surgery.The anterior vertebral height ratio and the posterior vertebral height ratio in group 1 after surgery were significantly higher than those in group 2.The Cobb angle after surgery was significantly lower in group 1 than in group 2(P<0.05).The canal-occupying ratio of the affected vertebrae was not significantly different between the two groups(P>0.05).Before surgery,there was no significant difference in the quality of life scores between the two groups(P>0.05).The above indicators were significantly improved after surgery compared with before surgery in each group.In addition,these indicators were markedly better in group 1 than in group 2 after surgery(P<0.05 for each).CONCLUSION One-stage combined anterior-posterior surgery effectively improves the function of the affected vertebrae and the life quality of patients with severe thoracolumbar fractures and spinal cord injury.This surgical approach is worthy of popularization in clinical use.展开更多
<strong>Background:</strong> Klippel Feil syndrome (KFS) is a congenital malformation characterised by the presence of, at least, one fused cervical segment and results from faulty segmentation along the e...<strong>Background:</strong> Klippel Feil syndrome (KFS) is a congenital malformation characterised by the presence of, at least, one fused cervical segment and results from faulty segmentation along the embryo’s developing axis during weeks 3 - 8 of gestation. The KFS increases the risk for spinal cord injury after minor trauma as a result of the disturbance of the biomechanics of the cervical spine. Persons with KFS often have associated congenital anomalies. <strong>Aim:</strong> The purpose of this study was to show the surgical management difficulties of this pathology in a low income country such as Senegal and to make a review of the literature. <strong>Case presentation:</strong> A 32-year-old man developed a tetraparesis secondary to a fall from his height while carrying a bag of rice on his head. Radiological explorations revealed fusedC2-C3 and C4-C5 vertebral bodies with a C3-C4 disc herniation associated to a spine contusion. The patient underwent surgical removal of the herniated disc via an anterior approach followed by interbody fusion and anterior plating. A complete recovery was noted at 4 months follow-up. <strong>Conclusion:</strong> Understanding of the cervical spine biomechanics of Klippel-Feil anomaly may allow an optimal management of patients. Patients with KFS should be warned of the increased risk of spinal cord injury after a low velocity trauma. Timing for surgery should be shortened.展开更多
This is an expert consensus on the evaluation and treatment of thoracolumbar spinal injury, estab- lished from February 2009 to July 2010. The expert consensus consists mainly of six parts with a total of 54 recommend...This is an expert consensus on the evaluation and treatment of thoracolumbar spinal injury, estab- lished from February 2009 to July 2010. The expert consensus consists mainly of six parts with a total of 54 recommendations including the overview (one item); pre-hospital care (one item); evaluation and diagnosis (13 items); treatment (23 items); prevention and treatment of major com- plications (12 items); and rehabilitation (four items). This is the first time that Chinese experts have published a consensus on spine and spinal cord injury. The expert consensus was established based on Delphi methods, literature analysis, and clinical experiences. Each recommendation is supported by and was interpreted using multi-level evidences. The level of agreement with the rec- ommendation among the panel members was assessed as either low, moderate, or strong. Each panel member was asked to indicate his or her level of agreement on a 5-point scale, with "1" cor- respondJng to neutrality and "5" representJng maxJmum agreement. Scores were aggregated across the panel members and an arithmetic mean was calculated. This mean score was then translated into low, moderate, or strong. After all of the votes were collected and calculated, the results showed no low-level recommendations, 10 moderate-level recommendations, and 44 strong-level recom- mendations. An expert consensus was reached and was recognized by Chinese spine surgeons. Wide-scale adoption of these recommendations is urgent in the management of acute thora- columbar spine and spinal cord injury in a broader attempt to create a standard evaluation and treatment strategy for acute thoracolumbar spine and spinal cord injury in China.展开更多
The duplication of animal models plays a key role in spinal cord injury research; however, there has been limited study into normal, external force-derived fracture dislocation. This study adopted experimental devices...The duplication of animal models plays a key role in spinal cord injury research; however, there has been limited study into normal, external force-derived fracture dislocation. This study adopted experimental devices, designed in-house, to construct standardized ventral and dorsal spinal cord injury animal models of 6 g and 17 g falling from a height of 2, 4, and 10 cm, and 15, 30 or 50 g transversal compression on the spinal cord. The results showed that gradual increases in the degree of histopathological injury led to decreased Tarlov and Basso, Beattie and Bresnahan scores for the behavioral test, and increased Ashworth scores for the hind limb. Furthermore, there was a gradual decline in the slope test in the rats with dorsal spinal cord injury that correlated to increases in the falling substance weight or falling height. Similar alterations were observed in the ventral spinal cord injured rats, proportional to the increase in compression weight. Our experimental findings indicate that the standardized experimental rat models of dorsal and ventral spinal cord injury are stable, reliable and reproducible.展开更多
AIM:To evaluate the methods and results of the AXIS lateral mass screw plate system in the treating of lower cervical spine injury.METHODS:29 cases of lower cervical vertebrae injury were fixed with AXIS system.All of...AIM:To evaluate the methods and results of the AXIS lateral mass screw plate system in the treating of lower cervical spine injury.METHODS:29 cases of lower cervical vertebrae injury were fixed with AXIS system.All of them were followed up for more than 1 year.RESULTS:All cases had a good bone union without malformation.We found no complication of the injury to the vertebral arteries or nerves.There was no loosening of the plate and screw. CONCLUSION:AXIS lateral mass screw plate system has the characteristic of stable,simple and safe and is suitable for the treatment of lower cervical spine injury.展开更多
Traumatic cervical spinal cord injury (SCI), with an annual incidence of 12,000 new cases in USA (NSCISC 2013), causes devastating locomotor and respiratory paralysis and unfortunately compromises the human patien...Traumatic cervical spinal cord injury (SCI), with an annual incidence of 12,000 new cases in USA (NSCISC 2013), causes devastating locomotor and respiratory paralysis and unfortunately compromises the human patient's lifespan. The severity of the injury depends on the degree and the extent of the initial trauma. In fact, respiratory failure is the leading cause of mortality following upper cervical SCI. However, 80% of the injuries are incomplete, allowing some modest spontaneous recovery. To date, no effective treatment is available in order to restore the loss of function.展开更多
Cervical spinal cord injury (SCI) results in partial to full paralysis of the upper and lower extrem- ities. Traditional primary endpoints for acute SCI clinical trials are too broad to assess functional recovery in...Cervical spinal cord injury (SCI) results in partial to full paralysis of the upper and lower extrem- ities. Traditional primary endpoints for acute SCI clinical trials are too broad to assess functional recovery in cervical subjects, raising the possibility of false positive outcomes in trials for cervical SCI. Endpoints focused on the recovery of hand and arm control (e.g., upper extremity motor score, motor level change) show the most potential for use as primary outcomes in upcoming trials of cervical SCI. As the field moves forward, the most reliable way to ensure meaningful clinical testing in cervical subjects may be the development of a composite primary endpoint that measures both neurological recovery and functional improvement.展开更多
Effect of platelet activating factor(PAF) on blood spinal cord barrier in cervical cord injury was investigated. Methods: Spinal cord injury at C6 segment was induced with Allen’s ’method in cats. PAF and PAF recept...Effect of platelet activating factor(PAF) on blood spinal cord barrier in cervical cord injury was investigated. Methods: Spinal cord injury at C6 segment was induced with Allen’s ’method in cats. PAF and PAF receptor antagonist BN52021 were administered by arachnoid space and intravenous injection respectively, and their effects on PAF levels, blood spinal cord barrier and cervical cord edema in the injuried zone and adjacent cervical cord tissue following cervical cord injury were investigated. Results: PAF levels, Evens content and water content in the injuried and adjacent cervical cord tissues significantly increased following trauma. PAF levels, Evens content and water content were evidently elevated with PAF by arachnoid space injection. PAF receptor antagonist BN52021 could inhibit the increase in PAF levels and reduce Evens and water content in the cervical cord tissue following trauma. Conclusion: PAF is an important contributing factor causing post-traumatic damage to the blood spinal cord barrier, while PAF receptor antagonist can effectively relieve post-traumatic damage to the blood spinal cord barrier.展开更多
Objective:To investigate the relationship between morphological abnormalities and spinal cord deficit in thoracolumbar burst fractures. Methods: Seventy-eight patients with thoracolumbar burst fractures were retrospec...Objective:To investigate the relationship between morphological abnormalities and spinal cord deficit in thoracolumbar burst fractures. Methods: Seventy-eight patients with thoracolumbar burst fractures were retrospectively reviewed to calculate the stenotic ratio of spinal canal based on the midsagittal diameters and the hyphosis angle according to Cobb. The ASIA scoring of motor function of lower extremities was recorded . Results: The differences (P > 0.05) of the stenotic ratio of spinal canal and the kyphosis angle were not significant between patients without neurological deficit, with incomplete and complete lesions. No significant correlation(P > 0.05) between the stenotic ratio of spinal canal and the kyphosis angle, and ASIA scoring was noted. Conclusion:The severity of spinal cord injuries in thoracolumbar burst fractures is not predicted according to the percentage of canal stenosis or the degree of kyphesis induced by thoracolumbar burst fractures.展开更多
Objective To analyze the clinical features of the multiple trauma patients combined with spine and spinal cord injuries.Methods A retrospective study was performed in143multiple trauma patients combined with spine and...Objective To analyze the clinical features of the multiple trauma patients combined with spine and spinal cord injuries.Methods A retrospective study was performed in143multiple trauma patients combined with spine and spinal展开更多
Acute traumatic spinal cord injury is often a lifechanging and devastating event with considerable mortality and morbidity.Over half a million people suffer from traumatic spinal cord injury annually with the majority...Acute traumatic spinal cord injury is often a lifechanging and devastating event with considerable mortality and morbidity.Over half a million people suffer from traumatic spinal cord injury annually with the majority resulting from road traffic accidents or falls.The Individual,societal and economic costs are enormous.Initial recognition and treatment of acute traumatic spinal cord injury are crucial to limit secondary injury to the spinal cord and to provide patients with the best chance of some functional recovery.This article is an overview of the management of the acute traumatic spinal cord injury patient presenting to the emergency department.We review the initial assessment,criteria for imaging and clearing the spine,and evaluate the literature to determine the optimum timing of surgery and the role of non-surgical treatment in patients presenting with acute spinal cord injury.展开更多
Recent studies have shown that mutation at Ser522 causes inhibition of collapsin response mediator protein 2(CRMP2) phosphorylation and induces axon elongation and partial recovery of the lost sensorimotor function af...Recent studies have shown that mutation at Ser522 causes inhibition of collapsin response mediator protein 2(CRMP2) phosphorylation and induces axon elongation and partial recovery of the lost sensorimotor function after spinal cord injury(SCI).We aimed to reveal the intracellular mechanism in axotomized neurons in the CRMP2 knock-in(CRMP2KI) mouse model by performing transcriptome analysis in mouse sensorimotor cortex using micro-dissection punching system.Prior to that, we analyzed the structural pathophysiology in axotomized or neighboring neurons after SCI and found that somatic atrophy and dendritic spine reduction in sensorimotor cortex were suppressed in CRMP2KI mice.Further analysis of the transcriptome has aided in the identification of four hemoglobin genes Hba-a1, Hba-a2, Hbb-bs, and Hbb-bt that are significantly upregulated in wild-type mice with concomitant upregulation of genes involved in the oxidative phosphorylation and ribosomal pathways after SCI.However, we observed substantial upregulation in channel activity genes and downregulation of genes regulating vesicles, synaptic function, glial cell differentiation in CRMP2KI mice.Moreover, the transcriptome profile of CRMP2KI mice has been discussed wherein energy metabolism and neuronal pathways were found to be differentially regulated.Our results showed that CRMP2KI mice displayed improved SCI pathophysiology not only via microtubule stabilization in neurons, but also possibly via the whole metabolic system in the central nervous system, response changes in glial cells, and synapses.Taken together, we reveal new insights on SCI pathophysiology and the regenerative mechanism of central nervous system by the inhibition of CRMP2 phosphorylation at Ser522.All these experiments were performed in accordance with the guidelines of the Institutional Animal Care and Use Committee at Waseda University, Japan(2017-A027 approved on March 21, 2017;2018-A003 approved on March 25, 2018;2019-A026 approved on March 25, 2019).展开更多
Paraplegic gait orthosis has been shown to help paraplegic patients stand and walk, although this method cannot be individualized for patients with different spinal cord injuries and functional recovery of the lower e...Paraplegic gait orthosis has been shown to help paraplegic patients stand and walk, although this method cannot be individualized for patients with different spinal cord injuries and functional recovery of the lower extremities. There is, however, a great need to develop individualized paraplegic orthosis to improve overall quality of life for paraplegic patients. In the present study, 36 spinal cord(below T4) injury patients were equally and randomly divided into control and observation groups. The control group received systematic rehabilitation training, including maintenance of joint range of motion, residual muscle strength training, standing training, balance training, and functional electrical stimulation. The observation group received an individualized paraplegic locomotion brace and functional training according to the various spinal cord injury levels and muscle strength based on comprehensive systematic rehabilitation training. After 3 months of rehabilitation training, the observation group achieved therapeutic locomotion in 8 cases, family-based locomotion in 7 cases, and community-based locomotion in 3 cases. However, locomotion was not achieved in any of the control group patients. These findings suggest that individualized paraplegic braces significantly improve activity of daily living and locomotion in patients with thoracolumbar spinal cord injury.展开更多
Degenerative cervical myelopathy is a common cause of spinal cord injury,with longer symptom duration and higher myelopathy severity indicating a worse prognosis.While numerous studies have investigated serological bi...Degenerative cervical myelopathy is a common cause of spinal cord injury,with longer symptom duration and higher myelopathy severity indicating a worse prognosis.While numerous studies have investigated serological biomarkers for acute spinal cord injury,few studies have explored such biomarkers for diagnosing degenerative cervical myelopathy.This study involved 30 patients with degenerative cervical myelopathy(51.3±7.3 years old,12 women and 18 men),seven healthy controls(25.7±1.7 years old,one woman and six men),and nine patients with cervical spondylotic radiculopathy(51.9±8.6 years old,three women and six men).Analysis of blood samples from the three groups showed clear differences in transcriptomic characteristics.Enrichment analysis identified 128 differentially expressed genes that were enriched in patients with neurological disabilities.Using least absolute shrinkage and selection operator analysis,we constructed a five-gene model(TBCD,TPM2,PNKD,EIF4G2,and AP5Z1)to diagnose degenerative cervical myelopathy with an accuracy of 93.5%.One-gene models(TCAP and SDHA)identified mild and severe degenerative cervical myelopathy with accuracies of 83.3%and 76.7%,respectively.Signatures of two immune cell types(memory B cells and memory-activated CD4^(+)T cells)predicted levels of lesions in degenerative cervical myelopathy with 80%accuracy.Our results suggest that peripheral blood RNA biomarkers could be used to predict lesion severity in degenerative cervical myelopathy.展开更多
Between 1990 and 1996, 15 patients with thoracolumbar spine fracture complicated by simple conusmedullaris injury were admitted. All patients were Injured by falling from height (mean, o meters). Clinical symp-toms in...Between 1990 and 1996, 15 patients with thoracolumbar spine fracture complicated by simple conusmedullaris injury were admitted. All patients were Injured by falling from height (mean, o meters). Clinical symp-toms indicated hypoesthesia or anesthesia of S3-5 sensory region,dysporia and urinary dysfunction. but normal sensation and motion of the bilateral lower extremities. Waston-Jones classified the spinal cord and nerve root injury following thoracolumbar spine fracture into three types. According to our observations, it should be classfied into five types: 1) concussion of the conus medullaris; 2) simple incomplete injury of the conus medullaris; 3) simplecomplete injury of the conus medullaris; 4) spinal cord transection and partial nerve root injury; 5) spinal cordtransection and entire nerve root injury.展开更多
Cervical spondylotic myelopathy is the main cause of non-traumatic spinal cord injury,with chronic static and/or dynamic compressive spinal cord injury as the unique pathogenesis.In the progression of this condition,t...Cervical spondylotic myelopathy is the main cause of non-traumatic spinal cord injury,with chronic static and/or dynamic compressive spinal cord injury as the unique pathogenesis.In the progression of this condition,the microvascular network is compressed and destroyed,resulting in ischemia and hypoxia.The main pathological changes are inflammation,damage to the blood spinal cord barriers,and cell apoptosis at the site of compression.Studies have confirmed that vascular regeneration and remodeling contribute to neural repair by promoting blood flow and the reconstruction of effective circulation to meet the nutrient and oxygen requirements for nerve repair.Surgical decompression is the most effective clinical treatment for this condition;however,in some patients,residual neurological dysfunction remains after decompression.Facilitating revascularization during compression and after decompression is therefore complementary to surgical treatment.In this review,we summarize the progress in research on chronic compressive spinal cord injury,covering both physiological and pathological changes after compression and decompression,and the regulatory mechanisms of vascular injury and repair.展开更多
基金supported by the National Natural Science Foundation of China,No.30672136(to HPL)
文摘Some studies have suggested that early surgical treatment can effectively improve the prognosis of cervical spinal cord injury without radiological abnormality, but no research has focused on the development of a prognostic model of cervical spinal cord injury without radiological abnormality. This retrospective analysis included 43 patients with cervical spinal cord injury without radiological abnormality. Seven potential factors were assessed: age, sex, external force strength causing damage, duration of disease, degree of cervical spinal stenosis, Japanese Orthopaedic Association score, and physiological cervical curvature. A model was established using multiple binary logistic regression analysis. The model was evaluated by concordant profiling and the area under the receiver operating characteristic curve. Bootstrapping was used for internal validation. The prognostic model was as follows: logit(P) =-25.4545 + 21.2576 VALUE + 1.2160SCORE-3.4224 TIME, where VALUE refers to the Pavlov ratio indicating the extent of cervical spinal stenosis, SCORE refers to the Japanese Orthopaedic Association score(0–17) after the operation, and TIME refers to the disease duration(from injury to operation). The area under the receiver operating characteristic curve for all patients was 0.8941(95% confidence interval, 0.7930–0.9952). Three factors assessed in the predictive model were associated with patient outcomes: a great extent of cervical stenosis, a poor preoperative neurological status, and a long disease duration. These three factors could worsen patient outcomes. Moreover, the disease prognosis was considered good when logit(P) ≥-2.5105. Overall, the model displayed a certain clinical value. This study was approved by the Biomedical Ethics Committee of the Second Affiliated Hospital of Xi'an Jiaotong University, China(approval number: 2018063) on May 8, 2018.
文摘Anesthesiologists work to prevent or minimize secondary injury of the nervous system and improve the outcome of medical procedures.To this end,anesthesiologists must have a thorough understanding of pathophysiology and optimize their skills and equipment to make an anesthesia plan.Anesthesiologists should conduct careful physical examinations of patients and consider neuroprotection at preoperative interviews,consider cervical spinal cord movement and compression during airway management,and suggest awake fiberoptic bronchoscope intubation for stable patients and direct laryngoscopy with manual in-line immobilization in emergency situations.During induction,anesthesiologists should avoid hypotension and depolarizing muscle relaxants.Mean artery pressure should be maintained within 85–90 mmHg(1 mmHg = 0.133 kPa; vasoactive drug selection and fluid management).Normal arterial carbon dioxide pressure and normal blood glucose levels should be maintained.Intraoperative neurophysiological monitoring is a useful option.Anesthesiologists should be attentive to postoperative respiratory insufficiency(carefully considering postoperative extubation),thrombus,and infection.In conclusion,anesthesiologists should carefully plan the treatment of patients with acute cervical spinal cord injuries to protect the nervous system and improve patient outcome.
基金supported by the Capital Characteristic Clinical Application Research Projects of Beijing Municipal Science and Technology Plan of China,No.Z16110000516009
文摘Decompression is the major therapeutic strategy for acute spinal cord injury,but there is some debate about the time window for decompression following spinal cord injury.An important goal and challenge in the treatment of spinal cord injury is inhibiting or reversing secondary injury.Governor Vessel electroacupuncture can improve symptoms of spinal cord injury by inhibiting cell apoptosis and improving the microenvironment of the injured spinal cord.In this study,Governor Vessel electroacupuncture combined with decompression at different time points was used to treat acute spinal cord injury.The rat models were established by inserting a balloon catheter into the atlanto-occipital space.The upper cervical spinal cord was compressed for 12 or 48 hours prior to decompression.Electroacupuncture was conducted at the acupoints Dazhui(GV14) and Baihui(GV 20)(2 Hz,15 minutes) once a day for 14 consecutive days.Compared with decompression alone,hind limb motor function recovery was superior after decompression for 12 and 48 hours combined with electroacupuncture.However,the recovery of motor function was not significantly different at 14 days after treatment in rats receiving decompression for 12 hours.Platelet-activating factor levels and caspase-9 protein expression were significantly reduced in rats receiving electroacupuncture compared with decompression alone.These findings indicate that compared with decompression alone,Governor Vessel electroacupuncture combined with delayed decompression(48 hours) is more effective in the treatment of upper cervical spinal cord injury.Governor Vessel electroacupuncture combined with early decompression(12 hours) can accelerate the recovery of nerve movement in rats with upper cervical spinal cord injury.Nevertheless,further studies are necessary to confirm whether it is possible to obtain additional benefit compared with early decompression alone.
基金supported by Scientific Research Project of Establishment of the Winter Olympics Sports Injury Rehabilitation Diagnosis and Treatment System and Green Channel Demonstration of China,No.2018YFF0301104(to JJL)China Rehabilitation Science Institute,No.2020cz-10(to WZW)Scientific Research Foundation of China Rehabilitation Research Center,No.2017zx-32(to XYZ)。
文摘In previous studies,researchers have used singing to treat respiratory function in patients with spinal cord injury.However,few studies have examined the way in which vocal training affects respiratory neural plasticity in patients with spinal cord injury.Vocal respiratory training(VRT)is a type of vocal muscle-related treatment that is often a component of music therapy(MT)and focuses on strengthening respiratory muscles and improving lung function.In this randomized controlled study,we analyzed the therapeutic effects of VRT on respiratory dysfunction at 3 months after cervical spinal cord injury.Of an initial group of 37 patients,26 completed the music therapy intervention,which comprised five 30-minute sessions per week for 12 weeks.The intervention group(n=13)received VRT training delivered by professional certified music therapists.The control group(n=13)received respiratory physical therapy delivered by professional physical therapists.Compared with the control group,we observed a substantial increase in respiratory function in the intervention group after the 12-week intervention.Further,the nerve fiber bundles in the respiratory center in the medulla exhibited a trend towards increased diversification,with an increased number,path length,thickness,and density of nerve fiber bundles.These findings provide strong evidence for the effect of music therapeutic VRT on neural plasticity.This study was approved by the Ethics Committee of China Rehabilitation Research Center(approval No.2020-013-1)on April 1,2020,and was registered with the Chinese Clinical Trial Registry(registration No.Chi CTR2000037871)on September 2,2020.
文摘BACKGROUND Thoracolumbar fractures are generally combined with spinal cord injury to varying degrees,which may cause deterioration of the patients’condition and increase the difficulty of clinical treatment.At present,anterior or combined anterior-posterior surgery is preferred for severe thoracolumbar fractures.AIM To investigate the effectiveness and postoperative rehabilitation of one-stage combined anterior-posterior surgery for severe thoracolumbar fractures with spinal cord injury.METHODS One-hundred-and-twenty patients who received surgery for severe thoracolumbar fractures with spinal cord injury at our hospital from February 2018 to February 2020 were randomly enrolled.They were randomly divided into group 1(one-stage combined anterior-posterior surgery,n=60)and group 2(onestage anterior-approach surgery,n=60).Treatment efficacy was compared between the two groups.RESULTS Blood loss was greater and the operation time was longer in group 1 than in group 2,and the differences were statistically significant(P<0.05).Incision length,intraoperative X-rays,and length of hospital stay were not significantly different between the two groups(P>0.05).Preoperative function of the affected vertebrae was not significantly different between the two groups(P>0.05).In each group,the patients showed significant improvement after surgery.The anterior vertebral height ratio and the posterior vertebral height ratio in group 1 after surgery were significantly higher than those in group 2.The Cobb angle after surgery was significantly lower in group 1 than in group 2(P<0.05).The canal-occupying ratio of the affected vertebrae was not significantly different between the two groups(P>0.05).Before surgery,there was no significant difference in the quality of life scores between the two groups(P>0.05).The above indicators were significantly improved after surgery compared with before surgery in each group.In addition,these indicators were markedly better in group 1 than in group 2 after surgery(P<0.05 for each).CONCLUSION One-stage combined anterior-posterior surgery effectively improves the function of the affected vertebrae and the life quality of patients with severe thoracolumbar fractures and spinal cord injury.This surgical approach is worthy of popularization in clinical use.
文摘<strong>Background:</strong> Klippel Feil syndrome (KFS) is a congenital malformation characterised by the presence of, at least, one fused cervical segment and results from faulty segmentation along the embryo’s developing axis during weeks 3 - 8 of gestation. The KFS increases the risk for spinal cord injury after minor trauma as a result of the disturbance of the biomechanics of the cervical spine. Persons with KFS often have associated congenital anomalies. <strong>Aim:</strong> The purpose of this study was to show the surgical management difficulties of this pathology in a low income country such as Senegal and to make a review of the literature. <strong>Case presentation:</strong> A 32-year-old man developed a tetraparesis secondary to a fall from his height while carrying a bag of rice on his head. Radiological explorations revealed fusedC2-C3 and C4-C5 vertebral bodies with a C3-C4 disc herniation associated to a spine contusion. The patient underwent surgical removal of the herniated disc via an anterior approach followed by interbody fusion and anterior plating. A complete recovery was noted at 4 months follow-up. <strong>Conclusion:</strong> Understanding of the cervical spine biomechanics of Klippel-Feil anomaly may allow an optimal management of patients. Patients with KFS should be warned of the increased risk of spinal cord injury after a low velocity trauma. Timing for surgery should be shortened.
基金supported by the Capital Medical Development Foundation of Beijing,No.2005-2016the Scientific and Technique Fund of the Chinese PLA during the Eleventh Five-Year Plan Period,No.06G028
文摘This is an expert consensus on the evaluation and treatment of thoracolumbar spinal injury, estab- lished from February 2009 to July 2010. The expert consensus consists mainly of six parts with a total of 54 recommendations including the overview (one item); pre-hospital care (one item); evaluation and diagnosis (13 items); treatment (23 items); prevention and treatment of major com- plications (12 items); and rehabilitation (four items). This is the first time that Chinese experts have published a consensus on spine and spinal cord injury. The expert consensus was established based on Delphi methods, literature analysis, and clinical experiences. Each recommendation is supported by and was interpreted using multi-level evidences. The level of agreement with the rec- ommendation among the panel members was assessed as either low, moderate, or strong. Each panel member was asked to indicate his or her level of agreement on a 5-point scale, with "1" cor- respondJng to neutrality and "5" representJng maxJmum agreement. Scores were aggregated across the panel members and an arithmetic mean was calculated. This mean score was then translated into low, moderate, or strong. After all of the votes were collected and calculated, the results showed no low-level recommendations, 10 moderate-level recommendations, and 44 strong-level recom- mendations. An expert consensus was reached and was recognized by Chinese spine surgeons. Wide-scale adoption of these recommendations is urgent in the management of acute thora- columbar spine and spinal cord injury in a broader attempt to create a standard evaluation and treatment strategy for acute thoracolumbar spine and spinal cord injury in China.
基金the National Natural Science Foundation of China for Youths, No.30901483the Natural Science Foundation of Shanxi Province for Youths,No. 2009021041-3Projects of Patent Promoteand Implementation of Shanxi Province, No.111009
文摘The duplication of animal models plays a key role in spinal cord injury research; however, there has been limited study into normal, external force-derived fracture dislocation. This study adopted experimental devices, designed in-house, to construct standardized ventral and dorsal spinal cord injury animal models of 6 g and 17 g falling from a height of 2, 4, and 10 cm, and 15, 30 or 50 g transversal compression on the spinal cord. The results showed that gradual increases in the degree of histopathological injury led to decreased Tarlov and Basso, Beattie and Bresnahan scores for the behavioral test, and increased Ashworth scores for the hind limb. Furthermore, there was a gradual decline in the slope test in the rats with dorsal spinal cord injury that correlated to increases in the falling substance weight or falling height. Similar alterations were observed in the ventral spinal cord injured rats, proportional to the increase in compression weight. Our experimental findings indicate that the standardized experimental rat models of dorsal and ventral spinal cord injury are stable, reliable and reproducible.
文摘AIM:To evaluate the methods and results of the AXIS lateral mass screw plate system in the treating of lower cervical spine injury.METHODS:29 cases of lower cervical vertebrae injury were fixed with AXIS system.All of them were followed up for more than 1 year.RESULTS:All cases had a good bone union without malformation.We found no complication of the injury to the vertebral arteries or nerves.There was no loosening of the plate and screw. CONCLUSION:AXIS lateral mass screw plate system has the characteristic of stable,simple and safe and is suitable for the treatment of lower cervical spine injury.
基金supported by funding from the European Union Seventh framework Programme(FP7/2007-2013)under grant agreement No.246556(European project RBUCEUP)HandiMedEx allocated by the French Public Investment Board,the Chancellerie des Universités de Paris(Legs Poix),theand the
文摘Traumatic cervical spinal cord injury (SCI), with an annual incidence of 12,000 new cases in USA (NSCISC 2013), causes devastating locomotor and respiratory paralysis and unfortunately compromises the human patient's lifespan. The severity of the injury depends on the degree and the extent of the initial trauma. In fact, respiratory failure is the leading cause of mortality following upper cervical SCI. However, 80% of the injuries are incomplete, allowing some modest spontaneous recovery. To date, no effective treatment is available in order to restore the loss of function.
文摘Cervical spinal cord injury (SCI) results in partial to full paralysis of the upper and lower extrem- ities. Traditional primary endpoints for acute SCI clinical trials are too broad to assess functional recovery in cervical subjects, raising the possibility of false positive outcomes in trials for cervical SCI. Endpoints focused on the recovery of hand and arm control (e.g., upper extremity motor score, motor level change) show the most potential for use as primary outcomes in upcoming trials of cervical SCI. As the field moves forward, the most reliable way to ensure meaningful clinical testing in cervical subjects may be the development of a composite primary endpoint that measures both neurological recovery and functional improvement.
文摘Effect of platelet activating factor(PAF) on blood spinal cord barrier in cervical cord injury was investigated. Methods: Spinal cord injury at C6 segment was induced with Allen’s ’method in cats. PAF and PAF receptor antagonist BN52021 were administered by arachnoid space and intravenous injection respectively, and their effects on PAF levels, blood spinal cord barrier and cervical cord edema in the injuried zone and adjacent cervical cord tissue following cervical cord injury were investigated. Results: PAF levels, Evens content and water content in the injuried and adjacent cervical cord tissues significantly increased following trauma. PAF levels, Evens content and water content were evidently elevated with PAF by arachnoid space injection. PAF receptor antagonist BN52021 could inhibit the increase in PAF levels and reduce Evens and water content in the cervical cord tissue following trauma. Conclusion: PAF is an important contributing factor causing post-traumatic damage to the blood spinal cord barrier, while PAF receptor antagonist can effectively relieve post-traumatic damage to the blood spinal cord barrier.
文摘Objective:To investigate the relationship between morphological abnormalities and spinal cord deficit in thoracolumbar burst fractures. Methods: Seventy-eight patients with thoracolumbar burst fractures were retrospectively reviewed to calculate the stenotic ratio of spinal canal based on the midsagittal diameters and the hyphosis angle according to Cobb. The ASIA scoring of motor function of lower extremities was recorded . Results: The differences (P > 0.05) of the stenotic ratio of spinal canal and the kyphosis angle were not significant between patients without neurological deficit, with incomplete and complete lesions. No significant correlation(P > 0.05) between the stenotic ratio of spinal canal and the kyphosis angle, and ASIA scoring was noted. Conclusion:The severity of spinal cord injuries in thoracolumbar burst fractures is not predicted according to the percentage of canal stenosis or the degree of kyphesis induced by thoracolumbar burst fractures.
文摘Objective To analyze the clinical features of the multiple trauma patients combined with spine and spinal cord injuries.Methods A retrospective study was performed in143multiple trauma patients combined with spine and spinal
文摘Acute traumatic spinal cord injury is often a lifechanging and devastating event with considerable mortality and morbidity.Over half a million people suffer from traumatic spinal cord injury annually with the majority resulting from road traffic accidents or falls.The Individual,societal and economic costs are enormous.Initial recognition and treatment of acute traumatic spinal cord injury are crucial to limit secondary injury to the spinal cord and to provide patients with the best chance of some functional recovery.This article is an overview of the management of the acute traumatic spinal cord injury patient presenting to the emergency department.We review the initial assessment,criteria for imaging and clearing the spine,and evaluate the literature to determine the optimum timing of surgery and the role of non-surgical treatment in patients presenting with acute spinal cord injury.
基金supported by Grants-in-Aid for Scientific Research on Priority Areas from The Ministry of Education, Culture, Sports, Science and Technology(No.26430043to TO)。
文摘Recent studies have shown that mutation at Ser522 causes inhibition of collapsin response mediator protein 2(CRMP2) phosphorylation and induces axon elongation and partial recovery of the lost sensorimotor function after spinal cord injury(SCI).We aimed to reveal the intracellular mechanism in axotomized neurons in the CRMP2 knock-in(CRMP2KI) mouse model by performing transcriptome analysis in mouse sensorimotor cortex using micro-dissection punching system.Prior to that, we analyzed the structural pathophysiology in axotomized or neighboring neurons after SCI and found that somatic atrophy and dendritic spine reduction in sensorimotor cortex were suppressed in CRMP2KI mice.Further analysis of the transcriptome has aided in the identification of four hemoglobin genes Hba-a1, Hba-a2, Hbb-bs, and Hbb-bt that are significantly upregulated in wild-type mice with concomitant upregulation of genes involved in the oxidative phosphorylation and ribosomal pathways after SCI.However, we observed substantial upregulation in channel activity genes and downregulation of genes regulating vesicles, synaptic function, glial cell differentiation in CRMP2KI mice.Moreover, the transcriptome profile of CRMP2KI mice has been discussed wherein energy metabolism and neuronal pathways were found to be differentially regulated.Our results showed that CRMP2KI mice displayed improved SCI pathophysiology not only via microtubule stabilization in neurons, but also possibly via the whole metabolic system in the central nervous system, response changes in glial cells, and synapses.Taken together, we reveal new insights on SCI pathophysiology and the regenerative mechanism of central nervous system by the inhibition of CRMP2 phosphorylation at Ser522.All these experiments were performed in accordance with the guidelines of the Institutional Animal Care and Use Committee at Waseda University, Japan(2017-A027 approved on March 21, 2017;2018-A003 approved on March 25, 2018;2019-A026 approved on March 25, 2019).
文摘Paraplegic gait orthosis has been shown to help paraplegic patients stand and walk, although this method cannot be individualized for patients with different spinal cord injuries and functional recovery of the lower extremities. There is, however, a great need to develop individualized paraplegic orthosis to improve overall quality of life for paraplegic patients. In the present study, 36 spinal cord(below T4) injury patients were equally and randomly divided into control and observation groups. The control group received systematic rehabilitation training, including maintenance of joint range of motion, residual muscle strength training, standing training, balance training, and functional electrical stimulation. The observation group received an individualized paraplegic locomotion brace and functional training according to the various spinal cord injury levels and muscle strength based on comprehensive systematic rehabilitation training. After 3 months of rehabilitation training, the observation group achieved therapeutic locomotion in 8 cases, family-based locomotion in 7 cases, and community-based locomotion in 3 cases. However, locomotion was not achieved in any of the control group patients. These findings suggest that individualized paraplegic braces significantly improve activity of daily living and locomotion in patients with thoracolumbar spinal cord injury.
基金supported by Hunan Provincial Key Research and Development Program,No.2021SK2002(to BW)the Natural Science Foundation of Hunan Province of China(General Program),No.2021JJ30938(to YL)。
文摘Degenerative cervical myelopathy is a common cause of spinal cord injury,with longer symptom duration and higher myelopathy severity indicating a worse prognosis.While numerous studies have investigated serological biomarkers for acute spinal cord injury,few studies have explored such biomarkers for diagnosing degenerative cervical myelopathy.This study involved 30 patients with degenerative cervical myelopathy(51.3±7.3 years old,12 women and 18 men),seven healthy controls(25.7±1.7 years old,one woman and six men),and nine patients with cervical spondylotic radiculopathy(51.9±8.6 years old,three women and six men).Analysis of blood samples from the three groups showed clear differences in transcriptomic characteristics.Enrichment analysis identified 128 differentially expressed genes that were enriched in patients with neurological disabilities.Using least absolute shrinkage and selection operator analysis,we constructed a five-gene model(TBCD,TPM2,PNKD,EIF4G2,and AP5Z1)to diagnose degenerative cervical myelopathy with an accuracy of 93.5%.One-gene models(TCAP and SDHA)identified mild and severe degenerative cervical myelopathy with accuracies of 83.3%and 76.7%,respectively.Signatures of two immune cell types(memory B cells and memory-activated CD4^(+)T cells)predicted levels of lesions in degenerative cervical myelopathy with 80%accuracy.Our results suggest that peripheral blood RNA biomarkers could be used to predict lesion severity in degenerative cervical myelopathy.
文摘Between 1990 and 1996, 15 patients with thoracolumbar spine fracture complicated by simple conusmedullaris injury were admitted. All patients were Injured by falling from height (mean, o meters). Clinical symp-toms indicated hypoesthesia or anesthesia of S3-5 sensory region,dysporia and urinary dysfunction. but normal sensation and motion of the bilateral lower extremities. Waston-Jones classified the spinal cord and nerve root injury following thoracolumbar spine fracture into three types. According to our observations, it should be classfied into five types: 1) concussion of the conus medullaris; 2) simple incomplete injury of the conus medullaris; 3) simplecomplete injury of the conus medullaris; 4) spinal cord transection and partial nerve root injury; 5) spinal cordtransection and entire nerve root injury.
基金supported by the National Natural Science Foundation of China,No.81450020(to HQL)。
文摘Cervical spondylotic myelopathy is the main cause of non-traumatic spinal cord injury,with chronic static and/or dynamic compressive spinal cord injury as the unique pathogenesis.In the progression of this condition,the microvascular network is compressed and destroyed,resulting in ischemia and hypoxia.The main pathological changes are inflammation,damage to the blood spinal cord barriers,and cell apoptosis at the site of compression.Studies have confirmed that vascular regeneration and remodeling contribute to neural repair by promoting blood flow and the reconstruction of effective circulation to meet the nutrient and oxygen requirements for nerve repair.Surgical decompression is the most effective clinical treatment for this condition;however,in some patients,residual neurological dysfunction remains after decompression.Facilitating revascularization during compression and after decompression is therefore complementary to surgical treatment.In this review,we summarize the progress in research on chronic compressive spinal cord injury,covering both physiological and pathological changes after compression and decompression,and the regulatory mechanisms of vascular injury and repair.