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The goal of this study was to assess the therapeutic potential of a 5-hour local spinal cord (SC) hypothermia by 4 °C saline on preservation of SC tissue at the injury epicentre and 3 cranial and caudal 10 mm long SC segments in a porcine experimental model of spinal cord injury (SCI). The SCI was inflicted through L3 laminectomy by a metallic rod moved by a velocity of 30 mm.sec−1, and operated by a computer-controlled apparatus. A group of 15 female minipigs 5‒8-month-old weighing 28‒35 kg was randomly divided into 5 subgroups (each composed of 3 animals): 1) sham controls; 2) SCI by force 8N; 3) SCI by force 8N, 5-hour hypothermia; 4) SCI by force 15N; 5) SCI by force 15N, 5-hour hypothermia. After a 9-week survival period, the minipigs were in deep general anaesthesia transcardially perfused by 5000 ml of saline and fixed by 5000 ml 4 % neutral paraformaldehyde. White and grey SC matter damage was evaluated in specimens cut from the epicentre of injury as well as 3 cranial and 3 caudal 10 mm long SC blocks dyed according to Luxol fast blue (LFB) with cresyl violet (CV) protocol for light microscopic observations. The percentage of preserved SC white and grey matter was assessed in microphotographs and compared with data from sham controls (considered 100 %). The data were statistically evaluated by ANOVA test, the difference P ˂ 0.05 was considered significant. Results of the study suggest that 5-hour local cooling of the epicentre of SCI is well tolerated and facilitates the preservation of SC tissue integrity. Additional experimental and preclinical studies are necessary before introducing the method in practice. [ABSTRACT FROM AUTHOR]

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Both anterior and posterior approaches have shown insignificant differences in good clinical outcomes with one over another advantages and disadvantages. This review aimed to provide evidence for the best management of subaxial cervical spine injuries and discuss the clinical outcomes and complications. Clinical studies of anterior versus posterior and anterior versus anterior–posterior (combined) approaches to subaxial cervical spine injury were searched electronically from PubMed, Medline, ScienceDirect, Cochrane Library, and other Internet databases. Clinical improvement, complication rates, and mortality rates showed no significant differences with an odds ratio of 1.09 (95% confidence interval [CI], 0.79–1.49; p=0.61) for the anterior versus posterior approach and an odds ratio of 1.05 (95% CI, 0.35–3.18; p=0.93) for the anterior versus the combined approach. Surgical duration and blood loss were significantly different between the anterior and posterior groups with a mean difference of −42.84 (95% CI, −64.39 to 21.29; p<0.0001); −212.91 (95% CI, −417.60 to 8.22; p=0.04), respectively, whereas the length of hospitalization did not (p=0.16). No difference was found between the groups when compared by clinical improvement and complication rate. Meanwhile, the anterior approach was superior to the posterior approach in terms of surgical duration, blood loss, and hospitalization length. [ABSTRACT FROM AUTHOR]

Both anterior and posterior approaches have shown insignificant differences in good clinical outcomes with one over another advantages and disadvantages. This review aimed to provide evidence for the best management of subaxial cervical spine injuries and discuss the clinical outcomes and complications. Clinical studies of anterior versus posterior and anterior versus anterior–posterior (combined) approaches to subaxial cervical spine injury were searched electronically from PubMed, Medline, ScienceDirect, Cochrane Library, and other Internet databases. Clinical improvement, complication rates, and mortality rates showed no significant differences with an odds ratio of 1.09 (95% confidence interval [CI], 0.79–1.49; p=0.61) for the anterior versus posterior approach and an odds ratio of 1.05 (95% CI, 0.35–3.18; p=0.93) for the anterior versus the combined approach. Surgical duration and blood loss were significantly different between the anterior and posterior groups with a mean difference of −42.84 (95% CI, −64.39 to 21.29; p

Neurogenic bowel management in persons with spinal cord injury (SCI) is an important issue due to the associated morbidities causing a significant impact on the persons’ quality of life (QOL) and burden the caregiver and healthcare services. Complications such as constipation, diarrhoea, incontinence, social embarrassment and autonomic dysreflexia can be managed effectively and resourcefully to counter the ill effects. In India, the incidence of SCI is 15,000, with a prevalence of 0.15 million; most are educationally and economically underprivileged with substandard living conditions. Complications associated with neurogenic bowel tend to impede the implementation of vocational rehabilitation and community integration measures. The goals of management are to prevent complications and improve the QOL of persons with SCI. With the revolutionary progress in medical science, many pharmacological, non-pharmacological and surgical options have been formulated to satisfactorily and effectively manage the neurogenic bowel. In this narrative review, we have tried to compile some of the most popular and time-tested options for managing neurogenic bowel in persons with SCI.

Objectives: This study was conducted to investigate the factors affecting mortality due to spinal cord traumain patients admitted to the intensive care unit (ICU).Methods: This study was conducted in a group of patients who were admitted to the ICU with a TraumaticSpinal Injuries (TSI) diagnosis. The researcher started sampling by assessing the documents of the patientshospitalized in the ICU, and the diagnosis of TSI was confirmed for them. Besides, utilizing a researcher-madechecklist, factors affecting the mortality of patients were identified. The data were analyzed using the SPSSsoftware version 16. P

Suicidal behavior is considered a worldwide social phenomenon and a serious public health problem. In this regard, people with traumatic spinal cord injury may be associated with low mood, depression, suicidal ideation, and behavior. To evaluate the factors associated with suicidal ideation in people with SCI, this is quantitative, cross-sectional, descriptive study was carried out in a virtual environment. In total, 200 people aged 18 or over with TSCI living in Brazil took part in the study. Data were collected using the Beck Scale for Suicidal Ideation, answered online by participants using SurveyMonkey®. The sample consisted of 200 participants, most of whom were male, from southeast Brazil, with a mean age of 36.22 years, a duration of injury of 134.4 months, and a 32.5% frequency of suicidal ideation, as suicidal ideation was also verified in relation to the variables of schooling, rehabilitation, and consequence of injury. A statistically significant relationship was found between the duration of injury and suicidal ideation. According to the results, a considerable percentage of these individuals still think about suicide. On the other hand, the duration of the injury showed a significant difference in relation to suicidal ideation, and it was observed that the shorter the duration of spinal cord injury, the greater the likelihood of suicidal ideation.

Brief episodes of low oxygen breathing (therapeutic acute intermittent hypoxia; tAIH) may serve as an effective plasticity-promoting primer to enhance the effects of transcutaneous spinal stimulation-enhanced walking therapy (WALKtSTIM) in persons with chronic (>1 year) spinal cord injury (SCI). Pre-clinical studies in rodents with SCI show that tAIH and WALKtSTIM therapies harness complementary mechanisms of plasticity to maximize walking recovery. Here, we present a multi-site clinical trial protocol designed to examine the influence of tAIH + WALKtSTIM on walking recovery in persons with chronic SCI. We hypothesize that daily (eight sessions, 2 weeks) tAIH + WALKtSTIM will elicit faster, more persistent improvements in walking recovery than either treatment alone. To test our hypothesis, we are conducting a placebo-controlled clinical trial on 60 SCI participants who randomly receive one of three interventions: tAIH + WALKtSTIM; Placebo + WALKtSTIM; and tAIH + WALKtSHAM. Participants receive daily tAIH (fifteen 90-sec episodes at 10% O2 with 60-sec intervals at 21% O2) or daily placebo (fifteen 90-sec episodes at 21% O2 with 60-sec intervals at 21% O2) before a 45-min session of WALKtSTIM or WALKtSHAM. Our primary outcome measures assess walking speed (10-Meter Walk Test), endurance (6-Minute Walk Test), and balance (Timed Up and Go Test). For safety, we also measure pain levels, spasticity, sleep behavior, cognition, and rates of systemic hypertension and autonomic dysreflexia. Assessments occur before, during, and after sessions, as well as at 1, 4, and 8 weeks post-intervention. Results from this study extend our understanding of the functional benefits of tAIH priming by investigating its capacity to boost the neuromodulatory effects of transcutaneous spinal stimulation on restoring walking after SCI. Given that there is no known cure for SCI and no single treatment is sufficient to overcome walking deficits, there is a critical need for combinatorial treatments that accelerate and anchor walking gains in persons with lifelong SCI. Trial Registration: ClinicalTrials.gov, NCT05563103.

Abstract A young stray entire female domestic shorthair cat was presented with symmetrical forelimb extensor rigidity, neck hyperextension and hindlimb paraplegia, characteristic of Schiff–Sherrington phenomenon (SSP), within 30 min of a motor vehicle accident. Radiographic and post‐mortem studies disclosed complete transection of the spinal cord from traumatic dorsocranial luxation of the second lumbar vertebra, displacement of the sacrum from the ilium, seventh lumbar and first caudal vertebrae and multiple pelvic fractures. Other causes of forelimb extensor rigidity and neck hyperextension such as decerebrate and decerebellate rigidity were excluded by a lack of neurological signs consistent with these entities and unremarkable findings on post‐mortem examination of the cranial cavity and brain and histological examination of the cerebrum, brainstem and cerebellum. To the best of the author's knowledge, this is the first report of SSP in the cat outside the experimental arena of decerebrate or non‐decerebrate preparations following post‐brachial spinal cord transection/cold block.

A young stray entire female domestic shorthair cat was presented with symmetrical forelimb extensor rigidity, neck hyperextension and hindlimb paraplegia, characteristic of Schiff–Sherrington phenomenon (SSP), within 30 min of a motor vehicle accident. Radiographic and post‐mortem studies disclosed complete transection of the spinal cord from traumatic dorsocranial luxation of the second lumbar vertebra, displacement of the sacrum from the ilium, seventh lumbar and first caudal vertebrae and multiple pelvic fractures. Other causes of forelimb extensor rigidity and neck hyperextension such as decerebrate and decerebellate rigidity were excluded by a lack of neurological signs consistent with these entities and unremarkable findings on post‐mortem examination of the cranial cavity and brain and histological examination of the cerebrum, brainstem and cerebellum. To the best of the author's knowledge, this is the first report of SSP in the cat outside the experimental arena of decerebrate or non‐decerebrate preparations following post‐brachial spinal cord transection/cold block. [ABSTRACT FROM AUTHOR]

Spinal cord injuries (SCIs) are catastrophic events in humans and animals. They often result in permanent loss of motor, sensory, and autonomic functions caudally from the site of the spinal cord (SC) lesion. The natural history of spontaneous recovery from SC trauma is disappointing and currently available therapeutic interventions fail to operate. Hence further research using bigger experimental animals or primates is necessary. The results of this study performed by the authors in 21 Göttingen-Minnesota-Liběchov female minipigs (3 sham controls, and 18 members of an experimental subgroup) showed that these animals are suitable for SCI research. All mini-pigs survived rather complex experiments carried out in general anaesthesia induced by 5 % thiopental solution administered i.v., maintained by endotracheal inhalation of 1.5 % sevoflurane with O2 as well as a subsequent 9-week monitoring period. The experimental procedures comprised of L3 laminectomy, SCI inflicted by computer-controlled metallic piston crushing the SC with 8N, 15N, or 18N force. After the SCIs there were 9 minipigs left over during the next 5.5 hours in general anaesthesia, without application of hypothermia, then the surgical wounds were sutured, and the animals were allowed to awaken under supervision. Just 30 min following SCIs was in 6 mini-pigs started with the 5-hour application of 4 °C saline via perfusion chambers placed at the epicenter of the SCI, the chambers were removed, surgical wounds sutured, and animals were allowed to awaken. Just 30 minutes following the SCIs, there was in 3 minipigs started with a 5-hour administration of ≈24 °C saline at the epicentre of the SCIs, and then the perfusion chamber was removed, surgical wounds sutured, and the animals were allowed to awaken. The 5.5-hour local hypothermia and protracted general anaesthesia required monitoring of rectal temperature, and external warming of the minipig, if the temperature dropped below 36 °C. The currently available information on the therapeutic capacity of the method, and all technical aspects of its routine employment, needs validation in further experiments and preclinical trials.

Ultrasound evaluation of diaphragm function allows the detection of diaphragm dysfunction and the adaptation of ventilatory support in patients admitted to intensive care units. The studied patient had a C3 spinal cord injury. Ultrasound evaluation of diaphragm mobility showed that the patient suffered diaphragm dysfunction. A tracheotomy was indicated, and early ventilatory support was initiated. Ultrasound evaluation of diaphragm function in patients with cervical spinal cord injury is a useful and simple technique. It provides fast and reliable data for the diagnosis of respiratory insufficiency of neuromuscular origin.

ABSTRACT Objective: To determine the epidemic profile of patients with spinal fractures referred for evaluation by Spine Group of IOT-HCFMUSP between 2019 and 2022. To enable the effect of the Covid-19 Pandemic on these epidemic profiles. Methods: We retrospectively analyzed the medical records of patients with spinal fractures referred by the São Paulo Center for the Regulation of Health Offers and Services (CROSS) to the Spine Group of IOT-HCFMUSP between 2019 and 2022. The epidemiological profile between the pre-pandemic Covid-19 period and the period of the Covid-19 pandemic until December 2022 in the city of São Paulo was compared. Results: The medical records of 427 patients were analyzed between March 2019 and December 2022. During the period, males accounted for 71.9% of cases, and the mean age was 46.7 years. Falls from heights were the most frequent trauma mechanism (63.7%), followed by motorcycle accidents (14.3%). The absence of neurological deficit occurred in 76.8% of the cases, and the most injured region was the lumbar region (39.3%). There were changes in the epidemiological profile during the Covid-19 pandemic compared to the pre-pandemic. Conclusions: A predominance of middle-aged males was observed, in addition to the trauma mechanism of falling from a height, as well as the absence of a neurological deficit in the initial evaluation. The lumbar and cervical regions were the most frequent sites of injury. The pandemic period interfered with the epidemiological profile presented and in the time interval between the injury and the evaluation at the IOT-HCFMUSP. Level of Evidence IV; Case Series.

Objective: To understand the experience of self-concept and social prejudice in the daily lives of people with spinal cord injury and their families. Methods: Interpretative, qualitative study, developed with 21 participants (12 people with spinal cord injury and 9 family members), of a Specialized Rehabilitation Center in southern Brazil, whose sources of evidence were individual interviews and two workshops that corroborate for data validation. For the grouping and organization of the data, the Atlas.ti software was used and the analysis of the data involved: preliminary analysis, ordering, key links, coding and categorization, guided by the gaze of Comprehensive Sociology and Everyday Life. Results: Evidence of self-concept: marks on the body and soul, wheelchair and the negative perception of the disease, from the decline to the reconstruction of self-image; prejudice in the dimensions: family and social. Conclusion: Self-prejudice negatively influences self-image, creating a mechanism of defense and denial of condition experiencing spinal cord injury. The family is decisive in everyday transformation the way that a person lives and perceives his condition. We need a sensibilization to look established preconceptions that imply about the segregation of people in society. [ABSTRACT FROM AUTHOR]

Incomplete spinal cord injury (iSCI) often results in lifelong walking impairments that limit functional independence. Thus, treatments that trigger enduring improvement in walking after iSCI are in high demand. Breathing brief episodes of low oxygen (i.e., acute intermittent hypoxia, AIH) enhances breathing and walking function in rodents and humans with chronic iSCI. Pre-clinical studies found that AIH also causes the accumulation of extracellular adenosine that undermines AIH-induced functional plasticity. Pharmacologically blocking adenosine A2a receptors (A2aR) prior to AIH resulted in a dramatic improvement in motor facilitation in rodents with iSCI; however, a similar beneficial effect in humans is unclear. Thus, we conducted a double-blind, placebo-controlled, crossover randomized study to test the hypothesis that a non-selective A2aR antagonist (i.e., caffeine) enhances AIH-induced effects on walking function in people with chronic (≥1yr) iSCI. We enrolled 12 participants to receive daily (5 days) caffeine or placebo (4 mg/kg) 30 min before breathing 15, 1.5-min low oxygen (AIH; FIO2 = 0.10) or SHAM (FIO2 = 0.21) episodes with 1-min intervals. We quantified walking function as the change in the 10-meter walk test (speed) and 6-min walk test (endurance) relative to baseline, on Day 5 post-intervention, and on follow-up Days 12 and 19. Participants walked faster (Day 19; p < 0.001) and farther (Day 19; p = 0.012) after caffeine+AIH and the boost in speed persisted more than after placebo+AIH or caffeine+SHAM (Day 19; p < 0.05). These results support our hypothesis that a caffeine pre-treatment to AIH training shows promise as a strategy to augment walking speed in persons with chronic iSCI. [ABSTRACT FROM AUTHOR]

Spinal cord injury (SCI) induces neurological deficits associated with longterm functional impairments. Since the current treatments remain ineffective, novel therapeutic options are needed. Besides its effect on bipolar mood disorder, lithium was reported to have neuroprotective activity in different neurodegenerative conditions, including SCI. In SCI, the effects of lithium on long-term neurological recovery and neuroplasticity have not been assessed. We herein investigated the effects of intraperitoneally administered lithium chloride (LiCl) on motor coordination recovery, electromyography (EMG) responses, histopathological injury and remodeling, and axonal plasticity in mice exposed to spinal cord transection. At a dose of 0.2, but not 2.0 mmol/kg, LiCl enhanced motor coordination and locomotor activity starting at 28 days post-injury (dpi), as assessed by a set of behavioral tests. Following electrical stimulation proximal to the hemitransection, LiCl at 0.2 mmol/kg decreased the latency and increased the amplitude of EMG responses in the denervated hindlimb at 56 dpi. Functional recovery was associated with reduced gray and white matter atrophy rostral and caudal to the hemitransection, increased neuronal survival and reduced astrogliosis in the dorsal and ventral horns caudal to the hemitransection, and increased regeneration of long-distance axons proximal and distal to the lesion site in mice receiving 0.2 mmol/kg, but not 2 mmol/kg LiCl, as assessed by histochemical and immunohistochemical studies combined with anterograde tract tracing. Our results indicate that LiCl induces long-term neurological recovery and neuroplasticity following SCI. [ABSTRACT FROM AUTHOR]

Copyright of Revista Habanera de Ciencias Médicas is the property of Universidad de Ciencias Medicas de La Habana and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

ABSTRACT Objectives: To evaluate the epidemiological profile of patients with spinal fractures over a two-year period (2017 and 2018) in a quaternary hospital in the city of São Paulo. Methods: A cross-sectional study was carried out through the analysis of the electronic medical records of patients treated by the Spine group of the Department of Orthopedics and Traumatology at the Orthopedics and Traumatology Emergency Room of Hospital das Clínicas de São Paulo in the years 2017 and 2018. Results: A total of 185 patients were evaluated over two years. Males were the gender most frequently evaluated (69.19%), and the mean patient age was 43.95 years. The most common trauma mechanisms were falls from a height (45.95%) and traffic accidents (29.73%). The cervical spine, affected in 28.65%, was the most affected region, followed by the thoracolumbar region (26.56%). Most patients did not present deficits at the initial moment (71.89%) and 54.05% of patients underwent surgery for treatment. Conclusion: Most traumas involving the spine affect adults of working age (from 20 to 60 years old), with a predominance of males. Most injuries occurred in the cervical region, which is the region most commonly associated with severe trauma and neurological injuries. This study can help in planning prevention and precaution strategies for spinal trauma. Level of evidence III; Cross-sectional study.

Graphene and graphene-based materials have the ability to induce stem cells to differentiate into neurons, which is necessary to overcome the current problems faced in the clinical treatment of spinal cord injury. This review summarizes the advantages of graphene and graphene-based materials (in particular, composite materials) in axonal repair after spinal cord injury. These materials have good histocompatibility, and mechanical and adsorption properties that can be targeted to improve the environment of axonal regeneration. They also have good conductivity, which allows them to make full use of electrical nerve signal stimulation in spinal cord tissue to promote axonal regeneration. Furthermore, they can be used as carriers of seed cells, trophic factors, and drugs in nerve tissue engineering scaffolds to provide a basis for constructing a local microenvironment after spinal cord injury. However, to achieve clinical adoption of graphene and graphene-based materials for the repair of spinal cord injury, further research is needed to reduce their toxicity.

Aortic impingement associated with traumatic thoracic spinal fractures is a rare and potentially lethal complication that creates management challenges in an already complex clinical problem. Traumatic aortic injury is one of the leading causes of death in blunt trauma. Magerl divided thoracic and lumbar fractures into 3 categories; the primary focus of this report, type C fractures, describes rotational injury and is one of the less common types, especially associated with aortic impingement as such. In this case, a young man was admitted following a near-fatal fall resulting in blunt force trauma to the midthoracic region. Emergency CT revealed a type C complete transection at the level of T11 and a grade I aortic injury. Definitive fixation of the spinal injury was delayed in favor of preventing further vascular injury by prioritizing the securing of hemodynamic stability. In traumatic thoracolumbar injuries, blunt traumatic aortic injury is often managed conservatively. However, blunt thoracic aortic injury is one of the leading causes of death from trauma, and each case requires its own case-by-case multidisciplinary management. In this occasion, management of the vascular insult was paramount to ensuring patient survival and favorable outcome.

Spinal cord injury (SCI) induces neurological deficits associated with long-term functional impairments. Since the current treatments remain ineffective, novel therapeutic options are needed. Besides its effect on bipolar mood disorder, lithium was reported to have neuroprotective activity in different neurodegenerative conditions, including SCI. In SCI, the effects of lithium on long-term neurological recovery and neuroplasticity have not been assessed. We herein investigated the effects of intraperitoneally administered lithium chloride (LiCl) on motor coordination recovery, electromyography (EMG) responses, histopathological injury and remodeling, and axonal plasticity in mice exposed to spinal cord transection. At a dose of 0.2, but not 2.0 mmol/kg, LiCl enhanced motor coordination and locomotor activity starting at 28 days post-injury (dpi), as assessed by a set of behavioral tests. Following electrical stimulation proximal to the hemitransection, LiCl at 0.2 mmol/kg decreased the latency and increased the amplitude of EMG responses in the denervated hindlimb at 56 dpi. Functional recovery was associated with reduced gray and white matter atrophy rostral and caudal to the hemitransection, increased neuronal survival and reduced astrogliosis in the dorsal and ventral horns caudal to the hemitransection, and increased regeneration of long-distance axons proximal and distal to the lesion site in mice receiving 0.2 mmol/kg, but not 2 mmol/kg LiCl, as assessed by histochemical and immunohistochemical studies combined with anterograde tract tracing. Our results indicate that LiCl induces long-term neurological recovery and neuroplasticity following SCI.

Study Design: Experimental study utilizing with a standardized model (MASCIS Impactor) of Spinal Cord Injury (SCI) in Balb C mouse model with implantation of mononuclear stem cells derived from the human umbilical cord and placenta blood in the early chronic phase of SCI., Objectives: The aim of this study was to evaluate the nerve regeneration and motor functional recovery in Balb C mice with surgically induced paraplegia in response to the use of mononuclear stem cells, in early chronic phase (> 2 weeks and < 6 months), because there is yet potential of neuronal and functional recovery as the neuronal scar is not still completely established., Methods: Forty-eight mice were randomly assigned to 6 groups of 8 animals. Group 1 received the stem cells 3 weeks after the trauma, and Group 2 received them six weeks later. In Group 3, saline solution was injected at the site of the lesion 3 weeks after the trauma, and in Group 4, 6 weeks later. Group 5 underwent only spinal cord injury and Group 6 underwent laminectomy only. The scales used for motor assessment were BMS and MFS for 12 weeks., Results: The intervention groups showed statistically significant motor improvement. In the histopathological analysis, the intervention groups had a lower degree of injury (p < 0.05). Regarding axonal budding, the intervention groups showed increasing in axonal budding in the caudal portion (p < 0.05)., Conclusions: The use of stem cells in mice in the chronic phase after 3 and 6 weeks of SCI brings functional and histopathological benefits to them., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Copyright © 2024 HCFMUSP. Published by Elsevier España, S.L.U. All rights reserved.)

Substantial clinical data support an association between superior neurological outcomes and early (within 24 h) surgical decompression for those with traumatic cervical spinal cord injury (SCI). Despite this, much discussion persists around feasibility and safety of this time threshold, particularly for those with a complete cervical SCI. This study aims to assess clinical practices and the safety profile of early surgery across a large sample of North American trauma centers. Data were derived from the Trauma Quality Improvement Program database from 2010–2016. Adult patients with a complete cervical SCI (American Spinal Injury Association [ASIA] A) who underwent surgery were included. Patients were stratified into those receiving surgery at or before 24 h and those receiving delayed intervention. Risk-adjusted variability in surgical timing across trauma centers was investigated using mixed-effects regression. In-hospital adverse events including death, major complications, and immobility-related complications were compared between groups after propensity score matching. There were 2862 patients from 353 North American trauma centers included; 1760 (61.5%) underwent surgery within 24 h. Case-mix and hospital-level characteristics explained only 6% of the variability in surgical timing both between centers and within centers. No significant differences in adverse events were identified between groups. These findings suggest a relatively large proportion of patients are not receiving surgery within the recommended time frame, despite apparent safety. Moreover, patient and hospital-level characteristics explain little of the variability in time-to-surgery. Further knowledge translation is needed to increase the proportion of patients in whom surgery is performed before the 24-h threshold so patients might reach their greatest potential for neurological recovery. [ABSTRACT FROM AUTHOR]

Introduction: Acute traumatic spinal cord injury is a complex injury affecting the nervous tissue of the spinal cord, vertebrae, joints, innervation and local vasculature, resulting in high mortality, physical dependence, stress, financial losses, lifelong risk of medical complications and reduced longevity. The complexity of the clinical repercussions of acute spinal cord trauma (SCI) makes early interventions necessary to ensure better prognosis. Emerging therapies with neuroprotective agents emerge Methodology: For the integrative literature review, the PubMed databases were used, Scielo, Google Scholar, Cochrane and the descriptors "spinal injury"; "spinal cord trauma"; "neuroprotective" and "drug therapy". Results: Therapies with corticosteroids, ion channel blockers, agonists and antagonists of neurotransmitters, cellular and genetic agents, vitamin D, progesterone, erythropoietin and caspase inhibitors demonstrated different neuroprotective effects involving reduction of secondary spinal cord injury and acceleration of neuronal recovery. in uneven research phases. Conclusion: It is concluded that preclinical studies with neuroprotectors as a potential treatment for TRM are promising, however, not all of them evolve into clinical trials, which limits the application of these therapies in humans. Therefore, it is necessary to improve research and clinical trials related to the use of neuroprotective agents in the management of traumatic acute spinal cord injury. [ABSTRACT FROM AUTHOR]

Abstract Background Restoring community walking remains a highly valued goal for persons recovering from traumatic incomplete spinal cord injury (SCI). Recently, studies report that brief episodes of low-oxygen breathing (acute intermittent hypoxia, AIH) may serve as an effective plasticity-inducing primer that enhances the effects of walking therapy in persons with chronic (> 1 year) SCI. More persistent walking recovery may occur following repetitive (weeks) AIH treatment involving persons with more acute SCI, but this possibility remains unknown. Here we present our clinical trial protocol, designed to examine the distinct influences of repetitive AIH, with and without walking practice, on walking recovery in persons with sub-acute SCI (

ABSTRACT Objective This paper proposes a retrospective analysis of the spinal cord trauma at a regional hospital that is a Unified Health System (SUS) reference in Orthopedics and Traumatology, considering epidemiological data and comparing treatments and hospitalization costs. Methods This study is a retrospective, analytical-descriptive, exploratory documental analysis, using data from the medical records of patients treated for spinal cord trauma during 2016 at the São José Municipal Hospital (Joinville, SC). Results Twenty-three patients were included in the study, 20 of whom (87%) were male. As to etiology, traffic accidents accounted for 47.8% of the cases and gunshot wounds were in second place with 26.1% of the injuries. The correlation between the cost of hospitalization and the days of hospitalization was statistically significant (p = 0.013), as was the correlation between the cost of hospitalization and the number of procedures (p = 0.000). Conclusions Surgical treatment demands greater amounts of financial and human resources. The purpose of this study is to provide local epidemiological data to encourage discussion about other studies, as well as planning for resource allocation and public policy. Level of evidence II; Retrospective Study.

Injuries resulting from being run over are the leading causes of vertebral fractures and dislocations, causing varying vertebral and spinal injuries. The present study aims to report the occurrence of traumatic injury to the spine of a mixed breed dog, aged four years, resulting in a T11-12 dislocation, with T11 exposure and spinal section, with the patient showing paraplegia, signs of an upper motor neuron lesion and absence of deep nociception in pelvic limbs. The treatment of choice was T11 vertebrectomy, associated with the alignment of T10-12 with the introduction of pins and fixation with polymethylmethacrylate (PMMA) associated with ceftriaxone. Due to a lesion in the parietal pleura during the surgery, thoracostomy was chosen to introduce a chest tube, which remained in the patient for four days. In the postoperative period, the patient presented a satisfactory recovery, and it was recommended that tutors make a wheelchair to facilitate their mobility. The technique proved to be satisfactory for minimizing infections that could occur in open fractures and improving the patient's quality of life, avoiding chronic pain. [ABSTRACT FROM AUTHOR]

Our objective was to track and quantify the natural course of serological markers over the 1st year following spinal cord injury. For that purpose, data on serological markers, demographics, and injury characteristics were extracted from medical records of a clinical trial (Sygen) and an ongoing observational cohort study (Murnau study). The primary outcomes were concentration/levels/amount of commonly collected serological markers at multiple time points. Two-way analysis of variance (ANOVA) and mixed-effects regression techniques were used to account for the longitudinal data and adjust for potential confounders. Trajectories of serological markers contained in both data sources were compared using the slope of progression. Our results show that, at baseline (≤ 2 weeks post-injury), most serological markers were at pathological levels, but returned to normal values over the course of 6–12 months post-injury. The baseline levels and longitudinal trajectories were dependent on injury severity. More complete injuries were associated with more pathological values (e.g., hematocrit, ANOVA test; χ2 = 68.93, df = 3, adjusted p value <0.001, and χ2 = 73.80, df = 3, adjusted p value <0.001, in the Sygen and Murnau studies, respectively). Comparing the two databases revealed some differences in the serological markers, which are likely attributable to differences in study design, sample size, and standard of care. We conclude that because of trauma-induced physiological perturbations, serological markers undergo marked changes over the course of recovery, from initial pathological levels that normalize within a year. The findings from this study are important, as they provide a benchmark for clinical decision making and prospective clinical trials. All results can be interactively explored on the Haemosurveillance web site (https://jutzelec.shinyapps.io/Haemosurveillance/) and GitHub repository (https://github.com/jutzca/Systemic-effects-of-Spinal-Cord-Injury). [ABSTRACT FROM AUTHOR]

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Background: Sever pain due to various reasons is one of the most important complaints of patients in the emergency department; so, management of pain is one of the main challenges there. The present study aimed to evaluate the effect of ketorolac in comparison to morphine on pain reduction in patients with spinal trauma in emergency department. Methods: This randomized controlled clinical trial study was done on 100 patients with spinal trauma who were randomly assigned in two groups of ketorolac (30 mg) and morphine (0.1 mg/kg). Drugs were infused in both groups in 100 cc normal saline solution during 15 minutes. Pain was assessed based on visual analog scale (from 0 means no pain to 10 means the worst pain possible), and adverse effects, as the main outcomes, were measured and compared between the groups at baseline, and minutes 5, 15, 30, 45, and 60 after drugs injection. Pain scores were compared using independent t test, and adverse effects using chi-square test. Findings: Pain score at minutes 45 and 60 after injection was significantly lower in ketorolac group than morphine group (P < 0.050). In morphine group, 34.8% of patients and in ketorolac group, only 2.1% of patients reported nausea during the study (P < 0.001). The trend of change in pain score was not significantly different between studied groups during study period (P = 0.106). Conclusion: Due to better effects of ketorolac on pain reduction in studied patients, with lower side effects in comparison to morphine, it seems that ketorolac can be considered as a good alternative of morphine for pain management in patients with spinal trauma referred emergency department.

Abstract Objective People living with spinal cord injuries are at a high risk to experience preventable secondary health conditions in their lifetime, which can lead to rehospitalisation and death. Given the fact that spinal cord injury is a long term disability requiring on-going care, there is need to strengthen prevention of secondary health conditions. This study aims to establish factors influencing prevention care for secondary health conditions among people living with spinal cord injuries in a metropolitan area in order to develop a prevention model of care. Results A record review of patients living with spinal cord injuries will be conducted to identify the prevalence of secondary health conditions and associated factors. Semi-structured interviews will be conducted on patients living with spinal cord injuries, their caregivers and therapists to explore the contextual factors (personal and environmental factors) influencing the prevention of secondary health conditions. Thematic analysis will be used to identify the themes. Nominal group technique will be used to develop the prevention model of care for secondary health conditions. This study will be conducted at a tertiary and specialised rehabilitation hospital in South Africa.

The purpose of this study was to report on long-term effects of low-frequency stimulation of the pelvic somatic nerves in patients with chronic spinal cord injuries who underwent laparoscopic implantation of neuroprosthesis (LION) in the pelvic lumbosacral nerves. Observational case report. Tertiary referral unit specialized in advanced gynecologic surgery and neuropelveology. Patients (N=29) with chronic SCI who underwent a LION procedure to the pelvic lower motor neurons for the recovery of standing and walking motion. Our study is not composed of preselected patients but includes patients across the entire range of SCIs: patients with paraplegia, patients with tetraplegia (except for high tetraplegia), patients with complete and incomplete SCIs, and even patients with flaccid or spastic paralysis. Patients underwent in-body functional electrical stimulation–assisted locomotor training and continuous low-frequency pelvic lumbosacral nerve neuromodulation. Evolution of American Spinal Injury Association (ASIA) sensory score, ASIA Lower Extremity Motor Score, and Walking Index. All patients with incomplete SCI regained some voluntary control of previously paralyzed muscles after a few months of stimulation training. With a follow-up of 9 years, 20 patients (71.4%) were able to demonstrate an electrically assisted voluntary extension of the knee. Twenty-six patients could get to their feet when the pacemaker was switched on (92.8%). Five patients could walk <10 m (17.85%) at the bar. Nineteen patients (Abbreviated Injury Score [AIS] A: n=8; AIS B: n=9; AIS C: n=2) could walk >10 m (67.8%), 8 of them only at the bar (28.5%) and 11 of them with the aid of crutches or a walker and without braces (40%). The major finding of our study is that 17 of 25 patients with complete motor chronic SCI (68%) developed enough recovery of supraspinal control of leg movements that voluntary walking became feasible, even though a minimal amount of stimulation may be required. [ABSTRACT FROM AUTHOR]

Objectives. To study the neurophysiological mechanisms of formation of motor deficit in patients with posttraumatic cervical myelopathy. Materials and methods. A retrospective clinical-neurophysiological study was performed from 2008 to 2018 involving 190 patients undergoing rehabilitation therapy at the Preodolenie Rehabilitation Center; the study included 39 women and 151 men, mean age 27 [21.0; 36.0] years, at 3 [1.0; 8.0] years after spinal cord trauma. On admission for rehabilitation therapy, all patients underwent investigations of neurological status with assessments on the International Standards for Neurological Classification of Spinal Cord Injury (ISNSCI) and nerve conduction studies. A total of 160 left and 145 right median nerves were investigated, along with 161 left and 151 right tibial nerves and 90 left and 66 right ulnar nerves. Total muscle potential (TMP) amplitudes were assessed, along with M responses and excitation conduction velocities (ECV) for the distal parts of motor fibers, repeat investigations were carried out (n = 95) at 6 [3.0; 10.0] years after trauma, the time between investigations being 2.9 [1.0; 4.0] years. The reference group for TMP and ECV of the median nerve consisted of 10 patients with traumatic paraplegia and the reference group for the tibial nerve consisted of 12 patients; there were no significant differences in age and sex composition. Results. In the study group, TMP amplitude in the median nerve was 4.1 [1.6; 6.1] mV and ECV was 56 [51.0; 61.0] m/sec, compared with TMP 11 [7.50; 16.40] mV (p = 0.00) and ECV 59 [58.0; 62.0] m/sec (p = 0.00) in the reference group; analysis of data for the tibial nerve in the study group gave TMP 4.3 [0.65; 7.95] mV and ECV 43 [39.0; 48.0] m/sec, with the reference group giving TMP 8.4 [6.4; 10.1] mV (p = 0.00) and ECV 50 [47.0; 51.0] m/sec (p = 0.00). Marked denervation changes were seen in 20% of patients. Signs of axonal neuropathy were more marked in all nerves in patients with complete spinal cord injury as compared with patients with partial injuries, while both tibial nerves showed decreased ECV. Studies of the median nerves in patients with lesions at C7–T1 showed significant reductions in TMP amplitude on the left (2.5 [0.55; 5.65] mV) and right (2.7 [0.80; 6.30] mV) as compared with patients with the clinical signs of lesions at C4–C6, in whom M responses on the left were 4.6 [2.30; 6.20] mV (p = 0.03) and on the right were 4.7 [2.80; 6.10] mV (p = 0.03). Conclusions. The main mechanism of peripheral nervous system damage in patients with posttraumatic cervical myelopathy was a combination of neuron damage at the level of the primary spinal cord lesions with secondary axonal neuropathy caudal to the injury level within three years of injury. [ABSTRACT FROM AUTHOR]

Aim: Spinal cord traumas have become a serious health problem with the increase in the ageing population in society. The present study aimed to show the anti-inflammatory activity of methylprednisolone and sinularia administered following spinal cord trauma. Materials and Methods: Sea corals are widely found on earth. Sinularia is one of the 17 known active substances of sinularia flexibilis, and several studies have been conducted on its anti-inflammatory, anti-oedema and cytotoxic effects. Despite the recent scientific studies, discussions continue as there are no effective treatment methods in use apart from methylprednisolone; however, the test animals received methylprednisolone treatment to compareits effects with those of sinularia, a secondary active ingredient of s. flexibilis. Results: Paired comparisons for serum IL-1β and tissue TNF-α were made with Dunn's test. When serum IL-1β and tissue TNF-α levels were evaluated, a significant difference was detected in the group taking sinularia treatment compared to the trauma group Sinularia treatment was more efficient on different cytokines and compared to methylprednisolone treatment used routinely, it significantly affected both IL-1β level and TNF-α levels in serum Conclusion: Anti-edematous, cytotoxic and anti-inflammatory effects of sinularia have been shown in our study. Sinularia, which has no known harmful effect on the human body according to the literature, may be clinically used in the future; however, more detailed and supportive experimental studies should be conducted on the subject. [ABSTRACT FROM AUTHOR]

Spine traumas and the resulting spinal cord injuries are among the most important health problems with their physical and psychosocial impacts due to significant mortality and morbidity. Our objective in this study was to evaluate the issues that should be taken into consideration during the intensive care treatment management of patients monitored for spinal cord trauma. Patient files were examined for obtaining the demographic and clinical properties of 68 patients followed up with spine trauma diagnosis at the Intensive Care Unit during the dates of June 2011- 2016. Age, gender, cause of trauma, trauma localization, trauma injury accompanying the spine trauma, deep vein thrombosis development, infection development, ASIA (American Spinal Injury Association) score, duration of intensive care stays, and properties were examined. An evaluation was made in our study according to ASIA scoring as a result of which it was determined that there are 4 ASIA A patients (5.88%) hospitalized or discharged, 5 ASIA B patients (7.35%), 14 ASIA C patients (20.58%), 24 ASIA D patients (35.29%) and 5 ASIA score E (neurologically intact) (7.35%) patients, while mortality rate was determined as 16 patients (23.52%). It was determined as a result of the evaluation carried out with regard to post-trauma intensive care unit length of stays that the average length of stay was 21.3 days with the shortest length of stay as 1 day and the longest as 96 days. Care attributes should be familiar for this patient group that requires a multidisciplinary approach and serious rehabilitation and a sufficient level of knowledge should be reached by all those involved in the follow-up procedure. [Med-Science 2018; 7(3.000): 561-4]

Spinal cord injury can lead to important functional, psychological and social sequelae. Despite the progress in medicine and greater understanding of the pathophysiological events associated with a traumatic spinal cord injury, spinal cord injury is still associated with a high morbidity and mortality. The involvement of the autonomic nervous system has implications in acute and chronic stages of the injured spinal cord patients. The most frequent cardiovascular complications in the acute phase of the traumatic spinal lesions are bradyarrhythmia, hypotension, increased vasovagal reflexes, ventricular and supraventricular ectopic beats, venous stasis, and vasodilation. In the chronic phase, we find orthostatic hypotension, alteration of the arterial pressure and the regulation of the body temperature as well as alteration of the blood volume. The knowledge of the cardiovascular alterations is of vital importance for the management and rehabilitation of the patients with spinal cord injury. In this article, we present a critical review of medical literature.

Hyponatremia is a common electrolyte disturbance usually observed in neurosurgical patients undergoing surgical management of traumatic, as well as, nontraumatic intracranial pathology. The spinal cord trauma is also associated with occasional development of such hyponatremia; it usually occurs within the first two-weeks of the injury. Hyponatremia can lead to alterations of consciousness, convulsions, coma, cardiac arrhythmias and on rare occasions, death. Authors present a practical oriented review of the literature.

Background: Restoring community walking remains a highly valued goal for persons recovering from traumatic incomplete spinal cord injury (SCI). Recently, studies report that brief episodes of low-oxygen breathing (acute intermittent hypoxia, AIH) may serve as an effective plasticity-inducing primer that enhances the effects of walking therapy in persons with chronic (> 1 year) SCI. More persistent walking recovery may occur following repetitive (weeks) AIH treatment involving persons with more acute SCI, but this possibility remains unknown. Here we present our clinical trial protocol, designed to examine the distinct influences of repetitive AIH, with and without walking practice, on walking recovery in persons with sub-acute SCI (< 12 months) SCI. Our overarching hypothesis is that daily exposure (10 sessions, 2 weeks) to AIH will enhance walking recovery in ambulatory and non-ambulatory persons with subacute (< 12 months) SCI, presumably by harnessing endogenous mechanisms of plasticity that occur soon after injury.Methods: To test our hypothesis, we are conducting a randomized, placebo-controlled clinical trial on 85 study participants who we stratify into two groups according to walking ability; those unable to walk (non-ambulatory group) and those able to walk (ambulatory group). The non-ambulatory group receives either daily AIH (15, 90s episodes at 10.0% O2 with 60s intervals at 20.9% O2) or daily SHAM (15, 90s episodes at 20.9% O2 with 60s intervals at 20.9% O2) intervention. The ambulatory group receives either 60-min walking practice (WALK), daily AIH + WALK, or daily SHAM+WALK intervention. Our primary outcome measures assess overground walking speed (10-Meter Walk Test), endurance (6-Minute Walk Test), and balance (Timed Up & Go Test). For safety, we also measure levels of pain, spasticity, systemic hypertension, and autonomic dysreflexia. We record outcome measures at baseline, days 5 and 10, and follow-ups at 1 week, 1 month, 6 months, and 12 months post-treatment.Discussion: The goal of this clinical trial is to reveal the extent to which daily AIH, alone or in combination with task-specific walking practice, safely promotes persistent recovery of walking in persons with traumatic, subacute SCI. Outcomes from this study may provide new insight into ways to enhance walking recovery in persons with SCI.Trial Registration: ClinicalTrials.gov, NCT02632422 . Registered 16 December 2015. [ABSTRACT FROM AUTHOR]

Objective: Cervical spinal canal stenosis is a well-known risk factor for spinal cord injury. In some patients, spinal cord injury is the first symptom of spinal stenosis. Therefore, some authors recommend preventive decompression of the spinal canal in asymptomatic patients with spinal stenosis. In this study, we aimed to determine the outcome of patients with spinal cord injury associated with cervical spinal canal stenosis and the rate of previously asymptomatic patients.Material and Methods: Data of 15 consecutive patients were evaluated. Improvement of neurological deficits during followup was accepted as good outcome and mortality and unchanging neurological deficits were accepted as worse outcome.Results: All patients were male, aged between 44 and 85 years. High-energy traumas caused injury in 7 of the cases and low-energy traumas in the others. Nine cases had central cord injury and 6 had other types of traumas. Only 2 patients had been diagnosed with minor symptoms associated with cervical canal stenosis before trauma, while the other patients had been asymptomatic. One patient did not consent to undergo an operation and two others could not be operated because of their general status; the latter 2 patients died. The other 12 patients were decompressed 0 to 40 days after trauma. Two other patients with severe transverse-type cord injury also died postoperatively. The other patients were followed for 1 to 48 months (22.7±17.7 months). In 2 patients, neurological deficits had not improved on last follow-up. Deficits had completely or partly improved in the other patients, including the one who had not accepted the operation. Central cord injury had a significantly better prognosis than other types (p=0.0019). Age, cervical canal diameter, and motor and sensory scores of the American Spinal Injury Association scale, type of trauma, and level of spinal cord injury were not significantly different in the patients with good and worse prognosis.Conclusion:The rate of asymptomatic patients before trauma was very high in patients with spinal cord injury associated with cervical spinal canal stenosis. Therefore, the treatment decision must be carefully assessed in asymptomatic cervical spinal stenosis patients. Catastrophic consequences of spinal trauma may be seen in patients with cervical spinal canal stenosis even in asymptomatic patients. Central cord syndrome had a good prognosis in these patients. Other types of injuries such as transverse and motor types had a worse outcome.

Objectives: This study was conducted to investigate the factors affecting mortality due to spinal cord trauma in patients admitted to the intensive care unit (ICU)., Methods: This study was conducted in a group of patients who were admitted to the ICU with a Traumatic Spinal Injuries (TSI) diagnosis. The researcher started sampling by assessing the documents of the patients hospitalized in the ICU, and the diagnosis of TSI was confirmed for them. Besides, utilizing a researcher-made checklist, factors affecting the mortality of patients were identified. The data were analyzed using the SPSS software version 16. P<0.05 was considered statistically significant., Results: About 412 (64.2%) patients were men, about 213 (33.2%) of the patients had GCS between 3-8 grade. There were injuries in the pelvis area. Moreover, there was a significant relationship between GCS score status and the number of injury follow-ups in addition to TSI. Therefore, the mortality rate was higher in patients who had lower GCS (Odds ratio=2.32, p <0.001). There was also a significant relationship between the number of injuries and the mortality rate, and patients who had multiple traumas had a higher mortality rate. Besides, a significant relationship was observed between the complications caused by trauma, including cerebrovascular accident, cardiac arrest, acute respiratory distress syndrome (ARDS), pneumonia, and the mortality of patients hospitalized in the SICU ( p <0.05)., Conclusion: The patients' mortality was influenced by factors such as their level of consciousness, the number of traumas caused in the spinal cord, and the occurrence of comorbidities such as cerebrovascular accident, cardiac arrest, ARDS, and pneumonia. Therefore, it is necessary to take the essential measures to reduce these complications., Competing Interests: The authors declared that there was no conflict of interest., (© Bulletin of Emergency And Trauma (BEAT).)

Brief episodes of low oxygen breathing (therapeutic acute intermittent hypoxia; tAIH) may serve as an effective plasticity-promoting primer to enhance the effects of transcutaneous spinal stimulation-enhanced walking therapy (WALK tSTIM ) in persons with chronic (>1 year) spinal cord injury (SCI). Pre-clinical studies in rodents with SCI show that tAIH and WALK tSTIM therapies harness complementary mechanisms of plasticity to maximize walking recovery. Here, we present a multi-site clinical trial protocol designed to examine the influence of tAIH + WALK tSTIM on walking recovery in persons with chronic SCI. We hypothesize that daily (eight sessions, 2 weeks) tAIH + WALK tSTIM will elicit faster, more persistent improvements in walking recovery than either treatment alone. To test our hypothesis, we are conducting a placebo-controlled clinical trial on 60 SCI participants who randomly receive one of three interventions: tAIH + WALK tSTIM ; Placebo + WALK tSTIM ; and tAIH + WALK tSHAM . Participants receive daily tAIH (fifteen 90-sec episodes at 10% O 2 with 60-sec intervals at 21% O 2 ) or daily placebo (fifteen 90-sec episodes at 21% O 2 with 60-sec intervals at 21% O 2 ) before a 45-min session of WALK tSTIM or WALK tSHAM . Our primary outcome measures assess walking speed (10-Meter Walk Test), endurance (6-Minute Walk Test), and balance (Timed Up and Go Test). For safety, we also measure pain levels, spasticity, sleep behavior, cognition, and rates of systemic hypertension and autonomic dysreflexia. Assessments occur before, during, and after sessions, as well as at 1, 4, and 8 weeks post-intervention. Results from this study extend our understanding of the functional benefits of tAIH priming by investigating its capacity to boost the neuromodulatory effects of transcutaneous spinal stimulation on restoring walking after SCI. Given that there is no known cure for SCI and no single treatment is sufficient to overcome walking deficits, there is a critical need for combinatorial treatments that accelerate and anchor walking gains in persons with lifelong SCI., Trial Registration: ClinicalTrials.gov, NCT05563103., Competing Interests: Drs. Gad and Edgerton are co-founders and hold shareholder interest in SpineX, Inc., (© William M. Muter et al., 2023; Published by Mary Ann Liebert, Inc.)

Aim: Prevalence and incidence of spinal cord injury (SCI) are low. However, sample sizes have not been systematically examined yet, although this might represent useful information for study planning and power considerations. Therefore, our objective was to determine the median sample size in clinical trials on SCI individuals. Moreover, within small‐sample size studies, statistical methods and awareness of potential problems regarding small samples were examined. Methods: We systematically reviewed all studies on human SCI individuals published between 2014 and 2015, where the effect of an intervention on one or more health‐related outcomes was assessed by means of a hypothesis test. If at least one group had a size <20, the study was classified as a small sample size study. PubMed was searched for eligible studies; subsequently, data on sample sizes and statistical methods were extracted and summarized descriptively. Results: Out of 8897 studies 207 were included. Median total sample size was 18 (range 4‐582). Small sample sizes were found in 167/207 (81%) studies, resulting limitations and implications for statistical analyses were mentioned in 109/167 (65%) studies. Conclusions: Although most recent SCI trials have been conducted with small samples, the consequences on statistical analysis methods and the validity of the results are rarely acknowledged. [ABSTRACT FROM AUTHOR]

Controversial findings about the effects of neuromuscular electrical stimulation and functional electrical stimulation in managing spasticity have been raised after spinal cord injury. A systematic review was conducted to identify the range of the stimulation parameters that may alleviate spasticity. Three independent reviewers searched Medline (PubMed), web of knowledge, Scopus, Cochrane Central, Virtual Health Library, and Physiotherapy Evidence Database until January 2018. Inclusion criteriawere applications of neuromuscular electrical stimulation/functional electrical stimulation on the lower limb muscles, stimulation parameters (frequency, pulse duration, and amplitude of current), and measures of spasticity after spinal cord injury. The primary outcome was spasticity as measured by the Modified Ashworth Scale and the secondary outcome was spasticity assessed by other indirect measures. Twenty-three clinical and nonclinical trials were included with 389 subjects. Neuromuscular electrical stimulation/functional electrical stimulation provided reductions in spasticity by 45%-60% with decrease in electromyography activity and increase in range of motion after spinal cord injury. The identified stimulation parameters were frequency of 20-30 Hz, pulse duration of 300-350 μs, and amplitude of the current greater than 100 mA. Neuromuscular electrical stimulation/functional electrical stimulation provides an effective rehabilitation strategy in managing spasticity. However, a recommendation of the stimulation parameters cannot be accurately assumed because of high variability in the methodology, design, and heterogeneity of the included studies. [ABSTRACT FROM AUTHOR]

The translation of therapeutic interventions to humans with spinal cord injury with the goal of promoting growth and repair in the central nervous system could, inadvertently, drive mechanisms associated with the development of neuropathic pain. A framework is needed to evaluate the probability that a therapeutic intervention for acute spinal cord injury modifies the progression of neuropathic pain. We analyzed a large, longitudinal dataset from the European Multi-Center Study about Spinal Cord Injury (EMSCI) and compared these observations with a previously published Swedish/Danish cohort. A meta-analysis was performed to produce aggregate estimates for the transition period between 1–6 months and the transition period between 1–12 months after injury. A secondary analysis used logistic regression to explore associations between the progression of neuropathic pain and demographics, pain characteristics, and injury characteristics. For overall neuropathic pain, 72% presenting with pain symptoms at one month reported persisting symptoms at six months, and 23% who did not have neuropathic pain at one month later had it develop. From 1–12 months, there was a similar likelihood of pain persisting (69%) and slightly higher rate of pain developing (36%). Characteristics that were significantly associated with the progression of pain included age and sensory and motor preservation. We provide historical benchmarks for estimating the progression of neuropathic pain during the first year after acute SCI. This information will be useful for comparison and evaluating safety during early phase acute spinal cord injury trials. [ABSTRACT FROM AUTHOR]

Introduction: Spinal cord lesions produce an exacerbated calcium input, being the most critical step after the spinal cord injury, mainly due to the activation of voltage-dependent calcium channels. Thus, calcium channel blockers could have a high potential to reduce spinal cord injuries. Aim: To evaluate the neuroprotective effect of omega-conotoxin MVIIC obtained from the poison of Conus magus in rats with spinal cord trauma. Methods: Thirty-six adult, male, Wistar rats were randomly divided into six groups. Animals in the negative control group underwent dorsal laminectomy. In the other groups, in addition to laminectomy, the animals underwent acute bruised trauma using the MASCIS impactor. Intrathecal placebo application was performed in the animals of the positive control groups. In groups G3 and G5 doses of 15 and 30 pmol of the Omega-conotoxin toxin MVIIC were applied, respectively, in the treated animals, 5 minutes after the trauma. In groups G4 and G6, doses of 15 and 30 pmol were applied, respectively, one hour after the trauma. Segments of the spinal cord were collected to quantify reactive oxygen species and lipid peroxidation, and to assess gene expression of factors related to apoptosis using a qRT-PCR technique. Results: No significant differences were found for the treatments evaluated regarding the free radical production and reactions of lipid peroxidation. However, the use of 15 pmol of omega-conotoxin MVIIC 1 hour after trauma tended to be better than the other evaluated doses. Conclusions: Omegaconotoxin MVIIC could be useful for the treatment of spinal cord trauma in rats. However, further studies are necessary to determine the adequate dose of this substance. [ABSTRACT FROM AUTHOR]

Spinal cord injuries (SCI) with their tragic consequences belong to the most serious pathological conditions. That is why they have stimulated basic research workers, as well as health care practitioners, to search for an effective treatment for decades. Animal experimental models have been essential in these efforts. We have jointly decided to test and standardize one of the spinal cord injury compression models in rats. Twentythree adult female Wistar rats weighing 250-320 g were utilized. Employing general anaesthesia along with a mixture of sevoflurane with O2, 2 rats (sham controls) had their vertebral arch of either Th8 or Th9 vertebra removed (laminectomy). The other 21 experimental rats with similar laminectomies were divided into 3 subgroups (n = 7) which received compression impact forces of 30, 40 or 50 g (subgroups-1, -2, and -3, respectively) applied on their exposed spinal medulla for 15 minutes. All rats were observed for 28 days after the experimental procedure and their motor functions were assessed by the Basso, Beattie, Bresnahan (BBB) test 6 hours, 7, 21 and 28 days after the simulated SCI. All 23 rats survived the surgical procedures. The control rats were without any neurological deficits. There were, in every experimental subgroup, 1 or 2 rats with extreme BBB scores. So the rats with the maximum and minimum BBB values were excluded. Then, the results acquired in the residual 5 rats in each group were averaged and statistically analysed by the Tukey multiple comparisons test. Statistically significant intersubgroup differences were found at all survival times equal to or longer than 7 post SCI days. The goal of the SCI experiment was to generate a reproducible and reliable, submaximal spinal cord trauma model. The statistical analyses demonstrated that this objective was best achieved in the subgroup-2 with the 40 g compression.