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  • ISSN: 2373-9479
    Volume 5, Issue 1
    Review Article
    Martin Quirno, Kirk AC, Andrew Y, Jason MC, Christian H, Pedro Ricart-Hoffiz, Tate A, Irina Mikolaenko, Thorsten K, and Thomas JE*
    Spinal cord injury during high-risk spinal deformity correction surgery occurs rarely despite best efforts to avoid it. Current neurophysiological monitoring strategies can only report an injury after it happens and some injuries fail to be captured intraoperatively. This catastrophic complication is usually irreversible. Using adult rats and an established spinal cord injury model, the objective of this study was to investigate whether prophylactic delivery of steroids directly to the region of injury via epidural injection, immediately prior to mechanical spinal cord injury, could prevent or reduce the long-term consequences of spinal cord injury.
    Methods: In adult rats, a previously described model of incomplete spinal cord injury (SCI) was utilized by introducing a size 2-French embolectomy catheter through a T10 laminotomy and compressing the cord by balloon inflation for 6 minutes. There were three study groups: the treatment group with prophylactic local epidural injection of methylprednisone (MP) 30 minutes prior to SCI (“SCI + MP”); the 1st control group with pre-operative normal saline (NS) administered epidurally 30 minutes before SCI (“SCI + NS”); and the 2nd control group with epidural injection of methylprednisone only, without SCI (“MP only”). Rats were evaluated weekly by two blinded evaluators for a period of 6 weeks utilizing the Basso-Beattie-Bresnahan (BBB) standardized behavioral scoring system.
    Results: The MP only group without SCI recovered from surgery rapidly without any behavioral indication of SCI. There was a significant improvement in average BBB scores in the MP only group at week 2-3 (versus post-operative day 1 [POD1]) in the 3-week data (p< 0.0169). Significant differences in the mean BBB score were determined in the SCI+MP group at weeks 1-3 (versus POD1) in the 3-week data (p< 0.0169). These behavioral improvements were not observed in the SCI+NS group over time. At 3 weeks post-SCI, both the SCI+NS and SCI+MP groups had significantly lower mean BBB scores than the MP only group (p< 0.005). At 6-weeks post-SCI, mean BBB scores were significantly different between the MP only group and the SCI+NS and SCI+MP groups (p< 0.05). Mean BBB scores were significantly higher for the SCI+MP group than for the SCI+NS group at weeks 2-4 (p< 0.05). Six weeks after SCI, the final mean BBB scores were 11.8 for the SCI+MP group versus 0.5 for the SCI+NS group.
    Conclusion: Rats treated with prophylactic, local, epidural MP prior to mechanical SCI recovered faster and to a significantly greater extent compared to those treated with saline only. Furthermore, epidural MP administration without SCI did not have any appreciable negative effects. Prophylactic treatment of high-risk spinal deformity surgery patients with a high concentration of epidural or intrathecal methylprednisolone may have potential to mitigate SCI severity. This possibility deserves further investigation in animals and human subjects.
    Melissa DeCelle* and Hassan Serhan
    Degenerative Disc Disease continues to have a global impact on the physical health of the aging population. The current gaps in the advancement of preventative and interventional treatment options and diagnostics have created an enormous opportunity for researchers and device/pharmaceutical companies to help bring solutions to patients with lower back pain. The pathomechanics of a degenerated disc are reviewed to lay the framework for further discussion regarding the progress and potential of cell-based and injectable technologies for treatment of DDD. However, challenges within this space must be understood and taken into consideration during clinical studies and product development. Aside from the clinical advantages, the value proposition and cost effectively for early and interventional treatment of DDD are reviewed.
    Florine Dallery, Malek Makki*, Cyrille Capel, Catherine Gondry-Jouet, and Olivier Baledent
    Purposes: Cine PC-MRI has shown that CSF oscillations increase with age, while the ratio between the CSF oscillation in the aqueduct and the spinal canal is constant. Our aim was to test whether the CSF hydrodynamic can bring complementary information to study pediatric population with an increase of the CSF volume.
    Material and Method: Forty three patients, newborns and children (mean age: 31 ± 32 months; 5 days - 111 months) with an intracranial CSF volume increase (ventricular or/and subarachnoid spaces) underwent a morphological MRI along with cine PC-MRI to quantify CSF oscillations. We defined a ratio of the ventricular area to that of the intracranial subarachnoid spaces (CSFratio). We also determined an index called CSFdynamic, which equals the CSF aqueduct stroke volume (SVAq) divided by the cervical stroke volume (SVC2C3) at the level C2C3 in the spine.
    Results: Twenty-three patients presented only ventricular dilatation: CSFdynamic = 20 ± 25; CSFratio: 120 ± 151; with no significant correlation, (rs = 0.152, p = 0.48). Sixteen patients presented both ventricular and subarachnoid space dilations: CSFdynamic = 18 ± 17; CSFratio = 1.67 ± 0.81; with significant positive correlation (rs = 0.5911 p = 0.016).
    Conclusion: In pediatric population, the absence of correlation between the dynamic of the CSF and its volume shows that the CSF oscillation does not result only of the size of the ventricles and/or the subarachnoid spaces. The CSF oscillations bring complementary information concerning the active aspect of the CSF.
    Case Report
    Jinjiong Hong, Liujun Zhao*, Yongjie Gu, Jie Li, Liang Yu, and Liran Wang
    A multilevel contiguous fracture of the subaxial cervical spine represents the severe trauma, and anterior plate fixation with anterior transpedicular screw fixation is a new and reliable fixation pattern for the treat-ment of acute spinal cord injury (ASCI). We present a case of multilevel contiguous fractures in the lower cervical spine without obvious posterior ligamentous complex injury, but with complete quadriplegia due to a falling accident. Computed tomography revealed multilevel contiguous fractures of the subaxial cer-vical spine including a posterior arch of atlas fracture with the sclerites of C5 vertebral body into the spinal canal with a major compression of the left anterior side of the cord. The patient was treated with a late surgery of C5, C6 corpectomies followed by a autologous bone graft with titanium mesh and surgical stabiliza tion of anterior transpedicular screw-plate system (ATPSP) through anterior approach only. At 1 year postoperative, the patient showed slight improvement except for urinary and fecal incontinence. The finger strength improved to grade 1 of 5 bilaterally, and muscular strength of lower extremities was grade 1 of 5 bilaterally. The latest follow-up showed the patient paralyzed without any further improvement at 2 years post operative. Anterior cervical plate fixation with anterior transpedicular screw fixation provides a new route of how to treat multilevel fractures of the subaxial cervical spine, and it is feasible. Surgical intervention provides rigid fixation and facilitates early rehabilitation, but the functional recovery of traumatic cervical spinal cord injury remains a difficult problem.
    Research Article
    Alexis N. Bowder, Joseph T. Cheatle, Jon Tefft, Sandeep K. Agrawal*, and Leslie C. Hellbusch
    Shunt malfunction in adult and pediatric populations continues to be a perplexing problem. We examined artificial cerebrospinal fluid flow differential between adult and pediatric shunt systems. Flow through adult and pediatric-sized catheters was compared with artificial CSF using shunt systems containing new catheters, explanted catheters, 2-piece catheters, 3-piece catheters and with varying protein levels. The adult and pediatric explanted catheters were: three different lengths (90cm, 52cm, and 25 cm) and were compared to new catheters of the same lengths. New pediatric-sized catheters have a statistically significant increase in resistance to flow when compared to adult catheters of the same lengths (p=0.0001). Explanted pediatric catheters had a slight increase in resistance to flow when compared to adult catheters of similar lengths. For both adult and pediatric-sized catheters, as concentration of protein increases, resistance to flow decreases (p<0.05). Resistance to flow in pediatric cerebrospinal fluid shunt systems containing 2-piece catheters, 3-piece catheters is higher than in comparable adult cerebrospinal fluid shunt systems. First study to examine the difference in flow dynamics between adult and pediatric shunts. The results suggest important finding that minimum pieces of shunts should be used to decrease chances of blockage.
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