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Neural precursor cell (NPC) transplantation represents a promising therapy for treating spinal cord injuries (SCIs); however, despite successful results obtained in preclinical models, the clinical translation of this approach remains challenging due, in part, to the lack of consensus on an optimal cell source for human neuronal cells. Depending on the cell source, additional limitations to NPC-based therapies include high tumorigenic potential, alongside poor graft survival and engraftment into host spinal tissue. We previously demonstrated that NPCs derived from rat fetal spinal cords primed with a polyglutamate (PGA)-conjugated form of the Rho/Rock inhibitor fasudil (PGA-SS-FAS) displayed enhanced neuronal differentiation and graft survival when compared to non-primed NPCs. We now conducted a similar study of human-fetal-spinal-cord-derived NPCs (hfNPCs) from legal gestational interruptions at the late gestational stage, at 19-21.6 weeks. In vitro, expanded hfNPCs retained neural features, multipotency, and self-renewal, which supported the development of a cell banking strategy. Before transplantation, we established a simple procedure to prime hfNPCs by overnight incubation with PGA-SS-FAS (at 50 µM FAS equiv.), which improved neuronal differentiation and overcame neurite-like retraction after lysophosphatidic-acid-induced Rho/Rock activation. The transplantation of primed hfNPCs into immune-deficient mice (NU( NCr)- Foxn1 nu ) immediately after the eighth thoracic segment compression prompted enhanced migration of grafted cells from the dorsal to the ventral spinal cord, increased preservation of GABAergic inhibitory Lbx1-expressing and glutamatergic excitatory Tlx3-expressing somatosensory interneurons, and elevated the numbers of preserved, c-Fos-expressing, activated neurons surrounding the injury epicenter, all in a low percentage. Overall, the priming procedure using PGA-SS-FAS could represent an alternative methodology to improve the capabilities of the hfNPC lines for a translational approach for acute SCI treatment.

Study Design: Retrospective analysis of a prospectively collected single-center database. Objective: We describe a modified halo-gravity traction (HGT) protocol for patients with severe spinal deformities in West Africa, and assess the clinical and radiographic outcomes. Summary of Background Data: Three-column osteotomies are frequently used in the correction of severe spinal deformities; however, these can be associated with high complication rates and significant risk for neurological injury. Preoperative traction is one modality used to obtain a partial correction prior to definitive fusion. Low numbers and variability of traction protocols, however, have limited previous reports of sustained HGT. Methods: All patients who underwent HGT in Ghana from April 2012 to August 2013 were reviewed. HGT was started at 20% body weight and increased by 10% per week until 50% body weight was reached by 4 weeks or thereafter as tolerated. Demographic variables, operative data, radiographic parameters, and healthrelated quality of life scores were collected. A deformity reduction index was calculated at each time point by summing the scoliosis and abnormal kyphosis for each patient and reported as a percentage of the preoperative deformity. Results: Twenty-nine patients underwent HGT for an average 107 days prior to definitive posterior spinal fusion (24 patients) or placement of growing rods (5 patients). The major curve improved from an average 131 ° to 90 ° (31%) after HGT, and to an average 57 ° (56%) postoperatively. Pure kyphotic curves were rigid (flexibility 22% after traction), with a correction index of 3.88, which is similar to historical controls. Deformity correction with HGT plateaued at 63 days. Overall Scoliosis Research Society-22 questionnaire scores improved significantly pretraction versus postoperatively, but there was no change after traction versus before traction. There were 11 pin tract infections, with no neurological complications. Conclusion: HGT is a safe method to partially correct severe spinal deformities prior to a definitive procedure, and may reduce the need for higher risk 3-column osteotomies. Importantly, kyphosis secondary to infection with spontaneous apical ankylosis is relatively resistant to HGT. © 2015, Wolters Kluwer Health, Inc. All rights reserved.

We report the case of a 21-year-old man with a unilateral lumbosacral dislocation together with a fracture of L1 resulting in "en bloc" dislocation, which is difficult to classify from an anatomopathological and biomechanical point of view. Unilateral lumbosacral dislocation is likewise an infrequent injury with less than 10 cases previously reported. Its association results in an anterior displacement to the left of the whole lumbar spine. To our knowledge, this displacement "en bloc" of the lumbar spine represents a rotatory dislocation of the same, an injury which we have not seen described until now in the literature.

PURPOSE: Designed for patients with adolescent idiopathic scoliosis, the SRS-22 is now widely used as an outcome instrument in patients with adult spinal deformity (ASD). No studies have confirmed the four-factor structure (pain, function, self-image, mental health) of the SRS-22 in ASD and under different contexts. Factorial invariance of an instrument over time and in different languages is essential to allow for precise interpretations of treatment success and comparisons across studies. This study sought to evaluate the invariance of the SRS-22 structure across different languages and sub-groups of ASD patients. METHODS: Confirmatory factor analysis was performed on the 20 non-management items of the SRS-22 with data from 245 American English-, 428 Spanish-, 229 Turkish-, 95 French-, and 195 German-speaking patients. Item loading invariance was compared across languages, age groups, etiologies, treatment groups, and assessment times. A separate sample of SRS-22 data from 772 American surgical patients with ASD was used for cross-validation. RESULTS: The factor structure fitted significantly better to the proposed four-factor solution than to a unifactorial solution. However, items 14 (personal relationships), 15 (financial difficulties), and 17 (days off work) consistently showed weak item loading within their factors across all language versions and in both baseline and follow-up datasets. A trimmed SRS (16 non-management items) that used the four least problematic items in each of the four domains yielded better-fitting models across all languages, but equivalence was still not reached. With this shorter version there was equivalence of item loading with respect to treatment (surgery vs conservative), time of assessment (baseline vs 12 months follow-up), and etiology (degenerative vs idiopathic), but not age (< vs ≥50 years). All findings were confirmed in the cross-validation sample. CONCLUSION: We recommend removal of the worst-fitting items from each of the four domains of the SRS-instrument (items 3, 14, 15, 17), together with adaptation and standardization of other items across language versions, to provide an improved version of the instrument with just 16 non-management items.