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Spinal cord injury (SCI) is a devastating condition that affects about 17,000 individuals every year in the United States, with approximately 294,000 people living with the ramifications of the initial injury. After the initial primary injury, SCI has a secondary phase during which the spinal cord sustains further injury due to ischemia, excitotoxicity, immune-mediated damage, mitochondrial dysfunction, apoptosis, and oxidative stress. The multifaceted injury progression process requires a sophisticated injury-monitoring technique for an accurate assessment of SCI patients. In this narrative review, we discuss SCI monitoring modalities, including pressure probes and catheters, micro dialysis, electrophysiologic measures, biomarkers, and imaging studies. The optimal next-generation injury monitoring setup should include multiple modalities and should integrate the data to produce a final simplified assessment of the injury and determine markers of intervention to improve patient outcomes. [ABSTRACT FROM AUTHOR]

The optimal decompression time for patients presenting with acute traumatic central cord syndrome (ATCCS) has been debated, and a high level of evidence is lacking. To compare early (<24 hours) versus late (≥24 hours) surgical decompression for ATCCS. Systematic review and meta-analysis. Medline, PubMed, Embase, and CENTRAL were searched from inception to March 15th, 2023. The primary outcome was American Spinal Injury Association (ASIA) motor score. Secondary outcomes were venous thromboembolism (VTE), total complications, overall mortality, hospital length of stay (LOS), and ICU LOS. The GRADE approach determined certainty in evidence. The nine studies included reported on 5,619 patients, of whom 2,099 (37.35%) underwent early decompression and 3520 (62.65%) underwent late decompression. The mean age (53.3 vs 56.2 years, p=.505) and admission ASIA motor score (mean difference [MD]=−0.31 [−3.61, 2.98], p=.85) were similar between the early and late decompression groups. At 6-month follow-up, the two groups were similar in ASIA motor score (MD= −3.30 [−8.24, 1.65], p=.19). However, at 1-year follow-up, the early decompression group had a higher ASIA motor score than the late decompression group in total (MD=4.89 [2.89, 6.88], p<.001, evidence: moderate), upper extremities (MD=2.59 [0.82, 4.36], p=.004) and lower extremities (MD=1.08 [0.34, 1.83], p=.004). Early decompression was also associated with lower VTE (odds ratio [OR]=0.41 [0.26, 0.65], p=.001, evidence: moderate), total complications (OR=0.53 [0.42, 0.67], p<.001, evidence: moderate), and hospital LOS (MD=−2.94 days [−3.83, −2.04], p<.001, evidence: moderate). Finally, ICU LOS (MD=−0.69 days [−1.65, 0.28], p=.16, evidence: very low) and overall mortality (OR=1.35 [0.93, 1.94], p=.11, evidence: moderate) were similar between the two groups. The meta-analysis of these studies demonstrated that early decompression was beneficial in terms of ASIA motor score, VTE, complications, and hospital LOS. Furthermore, early decompression did not increase mortality odds. Although treatment decision-making has been individualized, early decompression should be considered for patients presenting with ATCCS, provided that the surgeon deems it appropriate. [ABSTRACT FROM AUTHOR]

Lung cancer's propensity for spinal metastasis significantly impacts morbidity and mortality. The role of somatic mutations in determining the prognosis of these metastases is crucial for treatment optimization. To assess how somatic mutations affect survival and neurological outcomes in lung cancer patients with spinal metastases. A retrospective analysis was performed on 76 lung cancer patients at Johns Hopkins from 2013 to 2023 with spinal metastases to evaluate the impact of specific mutations and targeted therapy on prognosis. Inclusion criteria were based on a diagnosis of lung cancer with spinal metastasis and available genetic profiling data. The study focused on the correlation between survival and mutation status, the efficacy of targeted therapy, and postoperative neurological recovery. Data on demographics, tumor biomarkers, treatment modalities, and outcomes were collected and analyzed for each patient. In our study, 76 patients were analyzed, 95% with non-small-cell lung cancer (NSCLC), predominantly adenocarcinoma (83%). Genetic sequencing and immunohistochemical staining identified 61 unique biomarkers. EGFR mutations correlated with a notable increase in median overall survival (MOS) to 3.40 years from 1.39 years (p=0.014). KRAS+ patients had a significantly lower MOS at 0.71 years, compared to 2.60 years for those without KRAS mutations (p=0.03). Napsin A expression was associated with a substantial improvement in MOS to 5.41 years from 1.39 years (p=0.01), underscoring its prognostic value. The application of targeted therapy resulted in a MOS of 3.40 years, significantly better than 1.28 years observed without such treatment (p<0.01), indicating its efficacy in NSCLC management. Given that 95% of our study cohort were diagnosed with NSCLC, the observed improvement in MOS with targeted therapy primarily reflects outcomes in this population. Furthermore, Napsin A positively influenced postoperative neurological outcomes, as evidenced by improved Frankel scores (p=0.001), suggesting a role in patient recovery. In survival analysis, the overall median survival was 1.35 years (IQR 3.60 years), with the median time to first metastasis at 1.00 year (IQR 2.31 years) from diagnosis. The median time to spinal metastasis closely followed at 0.97 years (IQR 2.40 years), demonstrating the aggressive nature of NSCLC with spinal involvement. No significant difference was noted between the timing of the first and spinal metastases (p=0.71), nor between the median survival times post-first and spinal metastases (p=0.32). Accelerated Failure Time Model (AFT) analysis revealed immunotherapy (TR=2.15, p=0.007) and targeted therapy (TR=2.20, p=0.001) significantly improved survival, while radiotherapy to spinal metastasis was negatively associated with it (TR=0.46, p=0.015). Somatic mutations, especially EGFR, KRAS, and Napsin A, markedly influence survival in lung cancer patients with spinal metastases. Napsin A and targeted therapy were associated with better patient outcomes, underscoring the need for personalized treatment strategies to improve survival and neurological function. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

Ehlers-Danlos syndrome (EDS) is a rare hereditary condition that can result in ligamentous laxity and hypermobility of the cervical spine. A subset of patients can develop clinical instability of the craniocervical junction associated with pain and neurological dysfunction, potentially warranting treatment with occipitocervical fixation (OCF). Surgical decision-making in patients with EDS can be complicated by difficulty distinguishing from hypermobility inherent in the disease and true pathological instability necessitating intervention. Here we comprehensively review the available medical literature to critically appraise the evidence behind various proposed definitions of instability in the EDS population, and summarize the available outcomes data after OCF. Several radiographic parameters have been used, including the clivo-axial angle, basion-axial interval, and pB-C2 measurement. Despite increasing recognition of EDS by spine surgeons, there remains a paucity of data supporting proposed radiographic parameters for spinal instability among EDS patients. Furthermore, there is a lack of high-quality evidence concerning the efficacy of surgical treatments for chronic debilitating pain prevalent in this population. More standardized clinical measures and rigorous study methodologies are needed to elucidate the role of surgical intervention in this complex patient population. [ABSTRACT FROM AUTHOR]