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Mutepfa AR, Hardy JG, Adams CF. Electroactive Scaffolds to Improve Neural Stem Cell Therapy for Spinal Cord Injury. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 4:693438. [PMID: 35274106 PMCID: PMC8902299 DOI: 10.3389/fmedt.2022.693438] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 01/10/2022] [Indexed: 12/14/2022] Open
Abstract
Spinal cord injury (SCI) is a serious condition caused by damage to the spinal cord through trauma or disease, often with permanent debilitating effects. Globally, the prevalence of SCI is estimated between 40 to 80 cases per million people per year. Patients with SCI can experience devastating health and socioeconomic consequences from paralysis, which is a loss of motor, sensory and autonomic nerve function below the level of the injury that often accompanies SCI. SCI carries a high mortality and increased risk of premature death due to secondary complications. The health, social and economic consequences of SCI are significant, and therefore elucidation of the complex molecular processes that occur in SCI and development of novel effective treatments is critical. Despite advances in medicine for the SCI patient such as surgery and anaesthesiology, imaging, rehabilitation and drug discovery, there have been no definitive findings toward complete functional neurologic recovery. However, the advent of neural stem cell therapy and the engineering of functionalized biomaterials to facilitate cell transplantation and promote regeneration of damaged spinal cord tissue presents a potential avenue to advance SCI research. This review will explore this emerging field and identify new lines of research.
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Affiliation(s)
- Anthea R. Mutepfa
- Neural Tissue Engineering Keele, School of Life Sciences, Keele University, Keele, United Kingdom
| | - John G. Hardy
- Department of Chemistry, Lancaster University, Lancaster, United Kingdom
- Materials Science Institute, Lancaster University, Lancaster, United Kingdom
- *Correspondence: John G. Hardy
| | - Christopher F. Adams
- Neural Tissue Engineering Keele, School of Life Sciences, Keele University, Keele, United Kingdom
- Christopher F. Adams
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Bakhsh A, Aljuzair AH, Eldawoody H. An Epidemiological Overview of Spinal Trauma in the Kingdom of Saudi Arabia. Spine Surg Relat Res 2020; 4:300-304. [PMID: 33195853 PMCID: PMC7661028 DOI: 10.22603/ssrr.2019-0118] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 02/02/2020] [Indexed: 12/24/2022] Open
Abstract
Introduction The World Report on Road Traffic Injury Prevention indicates that by 2020, road traffic injuries will be a major killer, accounting for half a million deaths and 15 million disability-adjusted life years. The Kingdom of Saudi Arabia (KSA) has one of the highest rates of spinal cord injuries in the world, with 62 people injured per 1 million, and the injuries are mostly due to traffic accidents. Methods All polytrauma patients associated with spinal injuries admitted to Prince Mohammed bin Abdul Aziz Hospital (PMAH), Riyadh, from January 2017 to June 2018, were included in this study. Patients with old spinal injuries, any previous spinal surgery, spine infection, or concomitant diagnosed malignancies or osteoporotic collapse with or without falls were excluded. All patients underwent whole-spine computed tomography scan and, in selective cases, magnetic resonance imaging of the spine. Results Of the 230 patients, 90.0% were male, and 60% were in the second and third decades. Motor vehicle accidents were responsible for 83% of the cases, of which 50% of the victims were the drivers, and 80% were passengers with no seatbelt on. Nearly 50% of the spinal injuries were associated with injuries in the other body parts. Cervical spine injury accounted for 44% of the cases, followed by the lumbar spine injury. Twenty five percent of the patients presented with fixed neurologic deficit in the form of quadriplegia or paraplegia (ASIA-A). The mortality rate was 1.3%. Conclusions This study revealed that motor vehicle accidents are a major cause of spinal injuries in the KSA. One-fourth of the spinal Injuries are associated with complete spinal cord injuries. Therefore, in order to prevent lifelong disability in the young population, a nationwide program should be initiated to prevent road traffic accidents.
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Affiliation(s)
- Ahmed Bakhsh
- Department of Neurosurgery, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Ali Hassan Aljuzair
- Department of Neurosurgery, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Hany Eldawoody
- Department of Neurosurgery, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Kingdom of Saudi Arabia.,Department of Neurosurgery, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Muratore M, Ferrera A, Masse A, Bistolfi A. Can We Predict the Progression of Vertebral Collapse in Conservative Treatment of Osteoporotic Vertebral Fractures? A 3-Year Retrospective Study of 180 Patients From the Emergency Department. Int J Spine Surg 2020; 14:641-648. [PMID: 32986588 DOI: 10.14444/7084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Osteoporotic vertebral fractures (OVFs) have a high incidence in the elderly population and are usually treated conservatively with good outcomes. Nevertheless, failure of the conservative treatment may lead to serious complications. The aim of the study is to identify clinical, radiographic, and magnetic resonance imaging findings potentially related to the failure of the conservative treatment of OVFs. METHODS Data from 620 patients treated in the emergency department for vertebral fracture from 2014 to 2016 were analyzed; after patient identification and inclusion criteria, only fresh OVFs of patients older than 65 years have been included. Main outcome measurements were vertebral collapse, fracture shape types, and progression of vertebral collapse. A progression of vertebral collapse >100% was taken as an independent variable to underline the statistically significant difference among the risk factors. RESULTS A total of 180 patients (138 women; 42 men) and 200 OVFs were analyzed (mean age = 77 years, range = 65-94 years). Potential risks factors for the progression of vertebral collapse >100% were found when fractures occurred in the thoraco-lumbar junction. The swelling type and the bow-shaped type showed higher risk of vertebral collapse, while the concave was the most stable type of fracture with good prognosis. Traumatic fractures had lower risks of fracture progression compared to nontraumatic fractures (eg, fractures after an effort). A linear black signal pattern on short inversion time inversion recovery findings of magnetic resonance imaging corresponded to a risk of progression of the vertebral collapse. CONCLUSIONS Thoraco-lumbar fractures, swelling and bow-shaped fractures, and a linear black area at MR are negative prognostic factors for the failure of conservative treatment. LEVEL OF EVIDENCE 4. CLINICAL RELEVANCE The identification of negative prognostic factors may lead to different strategies of treatment to prevent vertebral collapse or failure of conservative treatment.
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Affiliation(s)
- Marco Muratore
- Hospital Città della Salute e della Scienza, Department of Orthopaedics, Traumatology, and Rehabilitation, Orthopaedic and Trauma Centre, CTO, Turin, Italy
| | - Andrea Ferrera
- University of the Studies of Turin, School of Orthopaedics and Traumatology, Turin, Italy
| | - Alessandro Masse
- Hospital Città della Salute e della Scienza, Department of Orthopaedics, Traumatology, and Rehabilitation, Orthopaedic and Trauma Centre, CTO, Turin, Italy.,University of the Studies of Turin, School of Orthopaedics and Traumatology, Turin, Italy
| | - Alessandro Bistolfi
- Hospital Città della Salute e della Scienza, Department of Orthopaedics, Traumatology, and Rehabilitation, Orthopaedic and Trauma Centre, CTO, Turin, Italy
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Oh S, Gustafsson L, Eames S. Current practice trends of oedema management in the hands of people with tetraplegia in Australia. Spinal Cord Ser Cases 2019; 5:71. [PMID: 31632729 PMCID: PMC6786418 DOI: 10.1038/s41394-019-0215-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/05/2019] [Accepted: 07/18/2019] [Indexed: 11/16/2022] Open
Abstract
Study design Survey research design. Objectives To describe current practice methods for oedema management in people with tetraplegia. Setting Australia. Methods Online survey with open and closed questions regarding clinical practice trends in the assessment and treatment of oedema in the hands in people with tetraplegia. Results Seventeen occupational therapists working in spinal cord injury (SCI) in Australia completed the survey. Oedema was identified by visual inspection (n = 17, 100%) and recorded using circumferential tape measurement (n = 13, 76%). Elevation was used by all participants in conjunction with compression gloves (n = 13, 76%), retrograde massage (n = 13, 76%), compression bandaging (n = 12, 71%) and the boxing glove splint (n = 9, 53%). Participants stated that oedema presented challenges to patients with difficulty exercising (n = 11, 65%), changes to body image (n = 5, 29%) and pain (n = 4, 24%). Conclusion Assessment and treatment practices were not consistent. Oedema in the hands in people with tetraplegia was perceived to have various impacts on a person's rehabilitation and hand function. The findings highlight the need for research evidence to guide practice.
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Affiliation(s)
- Soo Oh
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD Australia
- Occupational Therapy department, Princess Alexandra Hospital, Brisbane, QLD Australia
| | - Louise Gustafsson
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD Australia
- School of Allied Health Sciences, Griffith University, Brisbane, QLD Australia
| | - Sally Eames
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD Australia
- Community and Oral Health, Metro North Hospital and Health Service, Brisbane, QLD Australia
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Noonan VK, Chan E, Santos A, Soril L, Lewis R, Singh A, Cheng CL, O'Connell C, Truchon C, Paquet J, Christie S, Ethans K, Tsai E, Ford MH, Drew B, Linassi AG, Bailey CS, Fehlings MG. Traumatic Spinal Cord Injury Care in Canada: A Survey of Canadian Centers. J Neurotrauma 2017; 34:2848-2855. [PMID: 28367684 PMCID: PMC5653141 DOI: 10.1089/neu.2016.4928] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Specialized centers of care for persons sustaining a traumatic spinal cord injury (tSCI) have been established in many countries, but the ideal system of care has not been defined. The objective of this study was to describe care delivery, with a focus on structures and services, for persons with tSCI in Canada. A survey was sent to 26 facilities (12 acute, 11 rehabilitation, and three integrated) from eight provinces participating in the Access to Care and Timing project. The survey included questions about: 1) care provision; 2) structural attributes and; 3) service availability. Survey completion rate was 100%. Data sources used to complete the survey were the Rick Hansen Spinal Cord Injury Registry, other hospital databases, clinical protocols, and subject matter experts. Acute and rehabilitation care provided by integrated facilities were described separately, resulting in data from 15 acute and 14 rehabilitation facilities. The number of admissions for tSCI over a 12-month period between 2009-2011 ranged from 17 to 104 (median 39), and 11 to 96 (median 32), for acute and rehabilitation facilities, respectively. Grouping of patients was reported by 8/15 acute and 10/14 rehabilitation facilities. Criteria for admission to the inpatient rehabilitation facilities varied among facilities (25 different criteria reported). Results from the survey revealed similarities in the basic structure and the provision of general services, but also some differences in the degree of specialization of care for persons with tSCI. Continued work on the impact of specialized care for both the patient and healthcare system is needed.
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Affiliation(s)
| | - Elaine Chan
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | - Argelio Santos
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | - Lesley Soril
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | - Rachel Lewis
- Centre for Operations Excellence, Sauder School of Business, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anoushka Singh
- Spinal Cord Injury Clinical Research Unit, Toronto Western Hospital, Toronto, Ontario, Canada
| | | | - Colleen O'Connell
- Division of Physical Medicine and Rehabilitation, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Catherine Truchon
- Trauma and Critical Care Evaluation Unit, Institut national d'excellence en santé et en services sociaux, Québec City, Québec, Canada
| | - Jérôme Paquet
- Department of Surgery, Université Laval, Québec City, Québec, Canada
| | - Sean Christie
- Division of Neurosurgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Karen Ethans
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Eve Tsai
- Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Michael H. Ford
- Orthopedic Spine and Trauma, Integrated Spine Unit, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Brian Drew
- Department of Orthopedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - A. Gary Linassi
- Department of Physical Medicine and Rehabilitation, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Rai HH, Waqas M, Shamim MS. Low cost quality initiatives for management of neurosurgical patients in developing nations: Perspective from a tertiary care centre in Pakistan. Surg Neurol Int 2017; 8:35. [PMID: 28458949 PMCID: PMC5369258 DOI: 10.4103/sni.sni_352_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 01/12/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Targeting resources on cost-effective care strategies is pertinent for developing nations, specifically for already burdened specialties such as neurosurgery, where without state support and insurance companies, expenses are borne by the patient themselves. METHODS This was a descriptive review of literary work published by the section of neurosurgery at Aga Khan University Hospital, Pakistan. We searched PubMed and CiNAHL databases to identify articles, which were then critically analyzed and discussed from a perspective of low-cost quality care. RESULTS We demonstrate the cost effectiveness of three initiatives, namely, blood ordering protocol for elective spine arthrodesis, nonoperative management being superior to surgical stabilization in spine injury patients with complete neurological deficits, and early tracheostomy in patients with isolated severe traumatic brain injury. CONCLUSION Initiation and implementation of such cost-effective strategies without compromising quality health standards must be emphasized by neurosurgical centers throughout the developing world for smart allocation and utilization of funds.
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Affiliation(s)
- Hamid H. Rai
- Department of Surgery, Section of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Waqas
- Department of Surgery, Section of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad S. Shamim
- Department of Surgery, Section of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
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Kumar N, Osman A, Chowdhury J. Traumatic spinal cord injuries. J Clin Orthop Trauma 2017; 8:116-124. [PMID: 30202145 PMCID: PMC6128250 DOI: 10.1016/j.jcot.2017.06.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 06/07/2017] [Accepted: 06/10/2017] [Indexed: 11/26/2022] Open
Affiliation(s)
- Naveen Kumar
- Consultant Surgeon in Spinal Injuries, Midland Centre for Spinal Injuries,
RJAH Orthopaedic Hospital NHS Foundation Trust, Oswestry,
Shropshire SY10 7AG,
UK,Corresponding author.
| | - Aheed Osman
- Consultant Surgeon in Spinal Injuries, Midland Centre for Spinal Injuries,
RJAH Orthopaedic Hospital NHS Foundation Trust, Oswestry,
Shropshire SY10 7AG,
UK
| | - J.R. Chowdhury
- Clinical Lead & Consultant Surgeon in Spinal Injuries, Midland Centre for
Spinal Injuries, RJAH Orthopaedic Hospital NHS Foundation Trust,
Oswestry, Shropshire SY10
7AG, UK
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Rahimi-Movaghar V, Rasouli MR. Spinal cord decompression: Is country of surgery a predictor of outcome? Surg Neurol Int 2012; 3:36. [PMID: 22530171 PMCID: PMC3326945 DOI: 10.4103/2152-7806.94034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Accepted: 01/28/2012] [Indexed: 11/16/2022] Open
Affiliation(s)
- Vafa Rahimi-Movaghar
- Department of Neurosurgery, Shariati Hospital, Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Shamim MS, Ali SF, Enam SA. Non-operative management is superior to surgical stabilization in spine injury patients with complete neurological deficits: A perspective study from a developing world country, Pakistan. Surg Neurol Int 2011; 2:166. [PMID: 22145085 PMCID: PMC3229809 DOI: 10.4103/2152-7806.90027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Accepted: 09/27/2011] [Indexed: 11/17/2022] Open
Abstract
Background: Surgical stabilization of injured spine in patients with complete spinal cord injury is a common practice despite the lack of strong evidence supporting it. The aim of this study is to compare clinical outcomes and cost-effectiveness of surgical stabilization versus conservative management of spinal injury in patients with complete deficits, essentially from a developing country's point of view. Methods: A detailed analysis of patients with traumatic spine injury and complete deficits admitted at the Aga Khan University Hospital, Pakistan, from January 2004 till January 2010 was carried out. All patients presenting within 14 days of injury were divided in two groups, those who underwent stabilization procedures and those who were managed non-operatively. The two groups were compared with the endpoints being time to rehabilitation, length of hospital stay, 30 day morbidity/mortality, cost of treatment, and status at follow up. Results: Fifty-four patients fulfilled the inclusion criteria and half of these were operated. On comparing endpoints, patients in the operative group took longer time to rehabilitation (P-value = 0.002); had longer hospital stay (P-value = 0.006) which included longer length of stay in special care unit (P-value = 0.002) as well as intensive care unit (P-value = 0.004); and were associated with more complications, especially those related to infections (P-value = 0.002). The mean cost of treatment was also significantly higher in the operative group (USD 6,500) as compared to non-operative group (USD 1490) (P-value < 0.001). Conclusion: We recommend that patients with complete SCI should be managed non-operatively with a provision of surgery only if their rehabilitation is impeded due to pain or deformity.
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Affiliation(s)
- Muhammad Shahzad Shamim
- Department of Surgery, Section of Neurosurgery, Aga Khan University Hospital, Karachi 74800, Pakistan
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Saadoun S, Papadopoulos MC. Aquaporin-4 in brain and spinal cord oedema. Neuroscience 2009; 168:1036-46. [PMID: 19682555 DOI: 10.1016/j.neuroscience.2009.08.019] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Revised: 07/28/2009] [Accepted: 08/07/2009] [Indexed: 02/02/2023]
Abstract
Brain oedema is a major clinical problem produced by CNS diseases (e.g. stroke, brain tumour, brain abscess) and systemic diseases that secondarily affect the CNS (e.g. hyponatraemia, liver failure). The swollen brain is compressed against the surrounding dura and skull, which causes the intracranial pressure to rise, leading to brain ischaemia, herniation, and ultimately death. A water channel protein, aquaporin-4 (AQP4), is found in astrocyte foot processes (blood-brain border), the glia limitans (subarachnoid cerebrospinal fluid-brain border) and ependyma (ventricular cerebrospinal fluid-brain border). Experiments using mice lacking AQP4 or alpha syntrophin (which secondarily downregulate AQP4) showed that AQP4 facilitates oedema formation in diseases causing cytotoxic (cell swelling) oedema such as cerebral ischaemia, hyponatraemia and meningitis. In contrast, AQP4 facilitates oedema elimination in diseases causing vasogenic (vessel leak) oedema and therefore AQP4 deletion aggravates brain oedema produced by brain tumour and brain abscess. AQP4 is also important in spinal cord oedema. AQP4 deletion was associated with less cord oedema and improved outcome after compression spinal cord injury in mice. Here we consider the possible routes of oedema formation and elimination in the injured cord and speculate about the role of AQP4. Finally we discuss the role of AQP4 in neuromyelitis optica (NMO), an inflammatory demyelinating disease that produces oedema in the spinal cord and optic nerves. NMO patients have circulating AQP4 IgG autoantibody, which is now used for diagnosing NMO. We speculate how NMO-IgG might produce CNS inflammation, demyelination and oedema. Since AQP4 plays a key role in the pathogenesis of CNS oedema, we conclude that AQP4 inhibitors and activators may reduce CNS oedema in many diseases.
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Affiliation(s)
- S Saadoun
- Academic Neurosurgery Unit, St George's University of London, London SW17 0RE, UK
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