Association of Quantitative and Functional Imaging With Clinical Outcome After Spinal Cord Injury

Object In this report, the authors suggest evidence-based approaches to minimize the chance of perioperative spinal cord injury (POSCI) and optimize outcome in the event of a POSCI. Methods A systematic review of the basic science and clinical literature is presented. Results Authors of clinical studies have assessed intraoperative monitoring to minimize the chance of POSCI. Furthermore, preoperative factors and intraoperative issues that place patients at increased risk of POSCI have been identified, including developmental stenosis, ankylosing spondylitis, preexisting myelopathy, and severe deformity with spinal cord compromise. However, no studies have assessed methods to optimize outcomes specifically after POSCIs. There are a number of studies focussed on the pathophysiology of SCI and the minimization of secondary damage. These basic science and clinical studies are reviewed, and treatment options outlined in this article. Conclusions There are a number of treatment options, including maintenance of mean arterial blood pressure > 80 mm Hg, starting methylprednisolone treatment preoperatively, and multimodality monitoring to help prevent POSCI occurrence, minimize secondary damage, and potentially improve the clinical outcome of after a POSCI. Further prospective cohort studies are needed to delineate incidence rate, current practice patterns for preventing injury and minimizing the clinical consequences of POSCI, factors that may increase the risk of POSCI, and determinants of clinical outcome in the event of a POSCI.

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Magnetic resonance findings and outcome in ten cats with traumatic spondylomyelopathy

Vlaams Diergeneeskundig Tijdschrift ◽

10.21825/vdt.v84i4.16595 ◽

2015 ◽

Vol 84 (4) ◽

pp. 197-204

Author(s):

R. Tapia-Nieto ◽

G. B. Cherubini ◽

S. Jakovljevic ◽

A. Caine

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Clinical Outcome ◽

Case Series ◽

Low Field ◽

Muscle Trauma ◽

Bone Injury ◽

Cord Injury ◽

Post Traumatic ◽

Tissue Trauma

In this retrospective study, the MR findings of ten cats with acute post-traumatic spondylomyelopathy were described and the most useful MR sequences were determined. Spinal cord injury (SCI), bone and muscle trauma were compared with the clinical outcome (recovery or euthanasia). The extension of spinal cord injury (SCI) was measured in vertebral body length (VBL). Of the ten cats, only five fully recovered. In the recovery group, no SCI (n=1) or SCI <1 VBL (n=4) were found. In the group of euthanized dogs, SCI > 2 VBLs (n=4) or spinal cord transection (n=1) were found. Lesions were best seen on T2WSE (spinal cord injury), STIR (soft tissue trauma) and T1WSE (bone injury). Low-field MR was therefore helpful to assess feline spinal trauma and may prove helpful to predict the clinical outcome, although a larger case series is needed. The authors suggest that protocols with low-field MR should include T1WSE, T2WSE and STIR sequences.

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Relationship between Machine-Learning Image Classification of T2-Weighted Intramedullary Hypointensity on 3 Tesla Magnetic Resonance Imaging and Clinical Outcome in Dogs with Severe Spinal Cord Injury

Journal of Neurotrauma ◽

10.1089/neu.2020.7188 ◽

2020 ◽

Author(s):

Elizabeth Boudreau ◽

Arturo Otamendi ◽

Jonathan Levine ◽

John F. Griffin ◽

Lindsey Gilmour ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Machine Learning ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Magnetic Resonance ◽

Clinical Outcome ◽

Image Classification ◽

Resonance Imaging ◽

Cord Injury

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Dorsal and ventral horn atrophy is associated with clinical outcome after spinal cord injury

Neurology ◽

10.1212/wnl.0000000000005361 ◽

2018 ◽

Vol 90 (17) ◽

pp. e1510-e1522 ◽

Cited By ~ 11

Author(s):

Eveline Huber ◽

Gergely David ◽

Alan J. Thompson ◽

Nikolaus Weiskopf ◽

Siawoosh Mohammadi ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

White Matter ◽

Clinical Outcome ◽

Gray Matter ◽

Ventral Horn ◽

Tissue Specific ◽

Weighted Sequence ◽

Cord Injury ◽

Lesion Severity

ObjectiveTo investigate whether gray matter pathology above the level of injury, alongside white matter changes, also contributes to sensorimotor impairments after spinal cord injury.MethodsA 3T MRI protocol was acquired in 17 tetraplegic patients and 21 controls. A sagittal T2-weighted sequence was used to characterize lesion severity. At the C2-3 level, a high-resolution T2*-weighted sequence was used to assess cross-sectional areas of gray and white matter, including their subcompartments; a diffusion-weighted sequence was used to compute voxel-based diffusion indices. Regression models determined associations between lesion severity and tissue-specific neurodegeneration and associations between the latter with neurophysiologic and clinical outcome.ResultsNeurodegeneration was evident within the dorsal and ventral horns and white matter above the level of injury. Tract-specific neurodegeneration was associated with prolonged conduction of appropriate electrophysiologic recordings. Dorsal horn atrophy was associated with sensory outcome, while ventral horn atrophy was associated with motor outcome. White matter integrity of dorsal columns and corticospinal tracts was associated with daily-life independence.ConclusionOur results suggest that, next to anterograde and retrograde degeneration of white matter tracts, neuronal circuits within the spinal cord far above the level of injury undergo transsynaptic neurodegeneration, resulting in specific gray matter changes. Such improved understanding of tissue-specific cord pathology offers potential biomarkers with more efficient targeting and monitoring of neuroregenerative (i.e., white matter) and neuroprotective (i.e., gray matter) agents.

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Comparison of Post-Operative Clinical Outcome of Patients with PosteriorInstrumentation After Spinal Cord Injury in Thoracic, Thoracolumbar, and Lumbar Region at Haji Adam Malik General Hospital, Medan from 2016 to 2018

International Journal of PharmTech Research ◽

10.20902/ijptr.2019.130103 ◽

2020 ◽

Vol 13 (1) ◽

pp. 20-25

Author(s):

Budi Achmad M. Siregar ◽

Pranajaya Dharma Kadar ◽

Aga Shahri Putera Ketaren

Keyword(s):

Quality Of Life ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Clinical Outcome ◽

General Hospital ◽

Posterior Instrumentation ◽

Significance Level ◽

Sf 36 ◽

Cord Injury

Introduction : Spinal cord injury is a damaging situation related to severe disability and death after trauma.And the term spinal cord injury refers to damage of the spinal cord resulting from trauma. Spinal injuries treatment is still in debate for some cases, whether using conservative or surgical methods. Material and Methods : The study was a retrospective, unpaired observational analytic study with a crosssectional approach. It was conducted at Haji Adam Malik General Hospital, Medan from January 2016 to December 2018. Clinical outcome of patientswere calculated using SF 36, ODI, and VAS.Data would be tested using the Saphiro-Wilk test. We were using the significance level of 1% (0.01) and the relative significance level of 10% (0.1). Results : Clinical outcomes of patients with spinal cord injuries before posterior instrumentation rated using ODI and VAS were 75.93±6.75 and 4.75±0.98 respectively. Meanwhile, the scores were 10.75±3.29 (ODI) and 1.77±0.72 (VAS) post-operatively. Using SF-36, the scores were 72.9±16.5 (PF); 58±23.1 (PH); 63.1±21.8 (EP); 62.5±12 (ENE); 84.1±14.8 (EMO); 79.6±23.5 (SF); 62±125.3 (PAIN); 49.5±3.4 (GH); and 72±7.8 (HC) pre-operatively. After posterior instrumentation, the scores were 94.5±6.7 (PF); 100±0 (PH); 79.9±32.9 (EP); 88.6±13.7 (ENE); 92.3±1.7 (EMO); 100±0 (SF); 99.9±10.4 (PAIN); 89.3±14.9 (GH); and 92.4±9.7 (HC). Discussion : In this study, patients with thoracal, thoracolumbar and lumbar injuries who underwent surgery experienced significant improvements in quality of life. This is indicated by the significant difference in ODI, VAS, and SF-36 scores before and after surgery. The results of this study were consistent with other studies conducted by Hao et al, which showed that there was an improvement in the quality of life of patients after surgery. Conclusion : There are significant improvements in patient’s quality of life after posterior instrumentation of the spinal cord injury in thoracal, thoracolumbar, and lumbar regions based on the clinical outcomes.

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