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  • ISSN: 2373-9479
    Volume 4, Issue 2
    Research Article
    Bruno Benetti Junta Torres*, Bernardo De Caro Martins, Carla Maria Osorio Silva, Mario Sergio Lima Lavor, Sandro Coelho, Gabriela Ferreira Siano, and Eliane Goncalves de Melo
    This study aimed to evaluate the effects of bone marrow mesenchymal stromal cells (BMSC) and dantrolene (DAN) in spinal cord injury (SCI). Twenty-five male Wistar rats were divided into five groups: BMSC; BMSC+ DAN; DAN; positive control (PC) - trauma and placebo; and negative control (NC)-no trauma+placebo. Laminectomy was performed at T12 level in all animals, followed by a weight-drop model of SCI, except for the NC group. One hour later, the BMSC+DAN and DAN groups received 10mg/kg of DAN and after seven days the BMSC and BMSC+DAN groups received 1x106 BMSC intravenously. At those times, other groups received the same volume of placebo. Basso, Beattie, Bresnahan (BBB) locomotor scale was performed for 28 days to access neurological status. Traumatized animals showed severe paraplegia. There was a significant neurological improvement in groups BMSC, BMSC+ DAN and DAN from the 22th, 25thand 28thdays, respectively (p<0.05) compared to PC group. It was concluded that bone marrow mesenchymal stromal cells and dantrolene, alone or combined, for the treatment of SCI in rats promote functional neurological improvement.
    Short Communication
    Hamed Reihani Kermani*, Mohammad Ghasemi, Saeed Karamouzian, Maryam Amizadeh, and Amir Reihani Kermani
    Introduction: Bracing is an accepted part of operative treatment, however; the effectiveness of bracing is controversial. We sought evidences for the effect of Thoracolumbosacral Orthosis (TLSO) on spine proximal to the fusion site in patients treated for unstable thoracolumbar junction (TLJ) burst fractures.
    Materials and Methods: Fifty adult patients with unstable TLJ burst fractures are prospectively analyzed. All patients underwent posterior segmental instrumented spinal fusion. They were categorized into two groups randomly; the sample group (n=23) was recommended to wear a TLSO for eight weeks while the control (no brace) group was supposed not to use any orthosis. Fractured segmental kyphotic angle (FKA) and proximal kyphotic angle (PKA) were measured through standing lateral thoracolumbar x-rays by two independent observers twice after which mean value of four measurements was used.
    Results: Pre- and post-operative PKA were 6.35 ± 3.28 and 6.70 ± 3.41 (mean ± SD) degrees respectively (P=0.35) in which no statistical significant difference was observed. The mean and standard deviation of PKA among control group and TLSO group were 6.60 ± 3.43 and 6.79 ± 3.42 respectively (P=0.18), which did not show any statistical significant difference. Among all patients the differences of early post-op (7.65 ± 4.59 degree) and one year post-op (9.18 ± 5.04 degree) FKA with pre-op (17.25 ± 10.34 degree) FKA is statistically significant (P < 0.001).No differences were found between male and female regarding both FKA and PKA in one-year follow up.
    Conclusion: Based on the results of the study we found no evidence for the effectiveness of TLSO in surgically treated patients with TLJ unstable burst fractures. Treating these patients using early ambulation without TLSO eliminates the cost and patient deconditioning associated with a brace.
    Review Article
    Aakash Agarwal*, Manoj Kodigudla, Christian Schultz, Vijay K. Goel, and Anand K. Agarwal
    Study design: An in vitro biomechanical flexibility and fatigue test comparing two different lumbar interbody fusion cages using mono segmental lumbar spine specimens.
    Objective: To investigate and compare the stabilizing effect of a transforaminal lumbar interbody fusion (TLIF) cage against an expandable posterior lumbar interbody fusion (PLIF) cage.
    Method: Six intact human lumbar spine segments were divided into twelve functional spinal units (FSUs), with six samples for each type of cage. Pure moments were applied on intact, standalone cage, and standalone cage with pedicle screw-rod instrumentation (pre and post fatigue). The range of motion for every case was recorded and statistically analyzed to investigate the stabilization achieved with the two types of cages.
    Results and conclusion: The study found that the standalone expandable PLIF cages provide higher stabilization compared to TLIF cages, however in adjunct to pedicle screw system no significant differences exist between the two cages.
    Inaki Arrotegui*
    Study design: To evaluate the role played by the Layershield matrix (L.S.M.) in avoiding scar tissue and adhesion of the median nerve after decompression in carpal tunnel syndrome.
    Objective: Prospective randomized trial to examine this technique. The idea was to investigate the potential benefits when dealing with complications (adherence of the flexor tendons and severing or scarring of the median nerve using the two-inch matrix as an adhesion barrier following mini-open carpal tunnel release).
    Summary of background: The study cohort (L.S.M group) consisted of consecutive patients (200 patients) treated with L.S.M. Patients in the standard procedure group (200 patients in all) underwent operations using the same technique in carpal tunnel surgery in both groups, completing follow-up evaluations at no less than 3 to 6 months post-operation. The male to female ratio was 1:6. In twenty patients, there was bilateral involvement.
    Method: All operations were conducted by the author at the Hospital General Universitario de Valencia, and the Clinica La Salud, Valencia, Spain, between 2012 and 2013. All patients complained of numbness and or sensory disturbance or weakness in the median nerve distribution of the hand. Tinel and Phalen sign tests were positive in about two-thirds of patients. EMG studies were performed in all patients and were positive, ranging from mild to severe.
    Results: Numbness and paresthesia were relieved in 95% of patients in the L.S.M. group and 89% in the control group (CG). Pain was relieved in 95% DG and 90% CG. Motor weakness was relieved in 95% DG and 92% CG. Normal grip strength was evident in 93% DG and 91% had normal pinch strength.
    Re-operation rate: Adherence of the flexor tendons in 3 CG patients and 8 patients due to scarring involving the median nerve, with the L.S. matrix group undergoing re-operation for the following reasons: recurrent pain (3 patients due to scarring around the median nerve). The difference in the re-operation rate between the collagen matrix group and the standard procedure group is statistically significant (p<0.01).
    Conclusions: Findings in this study (reduced pain and lower incidence of adhesions) are consistent with the L.S. matrix acting as an effective adhesion barrier. By preventing median nerve adhesions, the L.S. matrix may significantly reduce the incidence of disabling pain associated with re-operation. Ultimately, the prophylactic use of the Layershield Matrix to prevent adhesions may result in improved patient outcomes.
    Case Report
    Walsh M, Gordhan A*, and Emelio Nardone
    Paraganglioma of the cauda equina presenting with subarachnoid hemorrhage, lower extremity motor weakness and urinary retention has not been previously reported. Paragangliomas of the cauda equina are confirmed after surgical resection, with no specific imaging criteria for the diagnosis. Imaging characteristics identified in this case report may allow for the tumor to be considered in the differential diagnosis as it may alert the surgeon against excessive manipulation of the lesion, which could lead to hypertensive crisis secondary to catecholamine release. Fluid-fluid levels within the dependent the cal sac by MRI consistent with subarachnoid hemorrhage and the presence of serpiginous vessels on myelographic studies should narrow the differential to paraganglioma versus hemangioblastoma. In addition, CT which has rarely been of use in diagnosing these lesions may be helpful when the presence of hemorrhage is detected.
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