Evaluation of clinical experience using cell-based therapies in patients with spinal cord injury: a systematic review

2012 ◽  
Vol 17 (Suppl1) ◽  
pp. 230-246 ◽  
Author(s):  
James S. Harrop ◽  
Robin Hashimoto ◽  
Dan Norvell ◽  
Annie Raich ◽  
Bizhan Aarabi ◽  
...  
Keyword(s):  
Spinal Cord ◽  
English Language ◽  
Spinal Cord Injuries ◽  
Case Reports ◽  
A Priori ◽  
Level Of Evidence ◽  
Hematopoietic Stem ◽  
Cellular Therapies ◽  
Cord Injury ◽  
Current Utilization

Object Using a systematic approach, the authors evaluated the current utilization, safety, and effectiveness of cellular therapies for traumatic spinal cord injuries (SCIs) in humans. Methods A systematic search and critical review of the literature published through mid-January 2012 was performed. Articles included in the search were restricted to the English language, studies with at least 10 patients, and those analyzing cellular therapies for traumatic SCI. Citations were evaluated for relevance using a priori criteria, and those that met the inclusion criteria were critically reviewed. Each article was then designated a level of evidence that was developed by the Oxford Centre for Evidence-Based Medicine. Results The initial literature search identified 651 relevant articles, which decreased to 350 after excluding case reports and reviews. Evaluation of articles at the title/abstract level, and later at the full-text level, limited the final article set to 12 papers. The following cellular therapies employed in humans with SCI are reviewed: bone marrow mesenchymal and hematopoietic stem cells (8 studies), olfactory ensheathing cells (2 studies), Schwann cells (1 study), and fetal neurogenic tissue (1 study). Overall the quality of the literature was very low, with 3 Grade III levels of evidence and 9 Grade IV studies. Conclusions Several different cellular-mediated strategies for adult SCI have been reported to be relatively safe with varying degrees of neurological recovery. However, the literature is of low quality and there is a need for improved preclinical studies and prospective, controlled clinical trials.

scholarly journals Treatment of posttraumatic syringomyelia: evidence from a systematic review

2020 ◽  
Vol 162 (10) ◽  
pp. 2541-2556
Author(s):  
Andrea Kleindienst ◽  
Francisco Marin Laut ◽  
Verena Roeckelein ◽  
Michael Buchfelder ◽  
Frank Dodoo-Schittko
Keyword(s):  
Spinal Cord ◽  
English Language ◽  
Spinal Cord Injuries ◽  
Case Reports ◽  
Treatment Options ◽  
Sensory Function ◽  
Time Interval ◽  
Eligibility Criteria ◽  
Cord Injury ◽  
Posttraumatic Syringomyelia

Abstract Background Following spinal cord injury (SCI), the routine use of magnetic resonance imaging (MRI) resulted in an incremental diagnosis of posttraumatic syringomyelia (PTS). However, facing four decades of preferred surgical treatment of PTS, no clear consensus on the recommended treatment exists. We review the literature on PTS regarding therapeutic strategies, outcomes, and complications. Methods We performed a systematic bibliographic search on (“spinal cord injuries” [Mesh] AND “syringomyelia” [Mesh]). English language literature published between 1980 and 2020 was gathered, and case reports and articles examining syrinx due to other causes were excluded. The type of study, interval injury to symptoms, severity and level of injury, therapeutic procedure, duration of follow-up, complications, and outcome were recorded. Results Forty-three observational studies including 1803 individuals met the eligibility criteria. The time interval from SCI to the diagnosis of PTS varied between 42 and 264 months. Eighty-nine percent of patients were treated surgically (n = 1605) with a complication rate of 26%. Symptoms improved in 43% of patients postoperatively and in 2% treated conservatively. Stable disease was documented in 50% of patients postoperatively and in 88% treated conservatively. The percentage of deterioration was similar (surgery 16%, 0.8% dead; conservative 10%). Detailed analysis of surgical outcome with regard to symptoms revealed that pain, motor, and sensory function could be improved in 43 to 55% of patients while motor function deteriorated in around 25%. The preferred methods of surgery were arachnoid lysis (48%) and syrinx drainage (31%). Conclusion Even diagnosing PTS early in its evolution with MRI, to date, no satisfactory standard treatment exists, and the present literature review shows similar outcomes, regardless of the treatment modality. Therefore, PTS remains a neurosurgical challenge. Additional research is required using appropriate study designs for improving treatment options.

What do we currently know about thoracic spinal cord injury recovery and outcomes? A systematic review

2012 ◽  
Vol 17 (Suppl1) ◽  
pp. 52-64 ◽  
Author(s):  
Richard J. Bransford ◽  
Jens R. Chapman ◽  
Andrea C. Skelly ◽  
Ellen M. VanAlstyne
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injuries ◽  
Poor Quality ◽  
Pulmonary Complications ◽  
Level Of Evidence ◽  
Thoracic Spinal Cord ◽  
Strength Of Evidence ◽  
Thoracic Spinal ◽  
Cord Injury ◽  
The Impact

Object The purpose of this paper was to systematically review and critically appraise the evidence for whether there are differences in outcomes or recovery after thoracic spinal cord injuries (SCIs) based on the spinal level, the timing of intervention, or cause of SCI. Methods Systematic searches were conducted using PubMed/MEDLINE through January 5, 2012. From 486 articles identified, 10 included data on the population of interest. Included studies were assigned a level of evidence (LOE) rating based on study quality, and an overall strength of evidence was assessed. To estimate the effect of injury level on patient outcomes, the relative risk and risk difference were calculated when data were available. Results From 486 citations identified, 3 registry studies and 7 retrospective cohort studies met the inclusion criteria. All were rated as being of poor quality (LOE III). Limited literature exists on the epidemiology of traumatic and nontraumatic SCI. Few studies evaluated outcomes based on SCI level within the thoracic spine. Pulmonary complications and thromboembolic events were less common in persons with lower thoracic SCI (T7–12) than in those with higher thoracic SCI (T1–6) in 2 large studies, but no differences were found in functional outcomes in 4 smaller studies. Patients undergoing earlier surgery (< 72 hours) may have fewer ventilator, ICU, and hospital days than those undergoing later surgery. One small study of SCI during repair of aortic aneurysm compared with traumatic SCI reported similar outcomes for both groups. There are substantial deficiencies in the scientific literature on thoracic SCI in regard to assessment, outcomes ratings, and effectiveness of therapy. Conclusions The overall strength of evidence for all outcomes reported is low. Definitive conclusions should not be drawn regarding the prognosis for outcome and recovery after thoracic SCI. From a physiological standpoint, additional methodologically rigorous studies that take into consideration various levels of injury in more anatomically and physiologically relevant form are needed. Use of validated, comprehensive outcomes tools are important to improve our understanding of the impact of thoracic SCI and aid in examining factors in recovery from thoracic SCI.

scholarly journals POSTURAL CONTROL ASSESSMENT IN PHYSICALLY ACTIVE AND SEDENTARY INDIVIDUALS WITH PARAPLEGIA

2017 ◽  
Vol 25 (4) ◽  
pp. 147-150 ◽  
Author(s):  
Paola Errera Magnani ◽  
Alberto Cliquet Junior ◽  
Daniela Cristina Carvalho de Abreu
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injuries ◽  
Spinal Injury ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Trunk Control ◽  
Level Of Evidence ◽  
Physically Active ◽  
Cord Injury ◽  
Complete Spinal Cord Injury

ABSTRACT Objective: The aim of this study was to evaluate functional independence and trunk control during maximum-range tasks in individuals with spinal cord injuries, who were divided into sedentary (SSI, n=10) and physically active (PASI, n=10) groups . Methods: Anamnesis was conducted and level and type of injury were identified (according to the American Spinal Injury Association protocol, ASIA) and the Functional Independence Measure (FIM) questionnaire was applied. For the forward and lateral reach task, the subjects were instructed to reach as far as possible. Mean data were compared using the unpaired t test and Mann-Whitney test and differences were considered significant when p<0.05 . Results: The PASI group performed better in self-care activities (PASI: 40.8±0.42 points, SSI: 38.0±3.58 points, p=0.01), sphincter control (PASI: 10.5±1.84 points, SSI: 8.2±3.04 points, p=0.02), transfers (PASI: 20.7±0.48 points, SSI: 16.9±4.27 points, p=0.04), and total FIM score (PASI: 104.0±2.30 points, SSI 105.1±8.56 points, p=0.01). On the maximum reach task, the PASI group had a greater average range in all directions evaluated (p<0.05) . Conclusion: The continuous practice of exercise increased motor function independence and trunk control in individuals with complete spinal cord injury. Level of Evidence II, Prospective Comparative Study.

scholarly journals Magnetic resonance imaging in lumbar gunshot wounds: an absolute contraindication?

2014 ◽  
Vol 37 (1) ◽  
pp. E13 ◽  
Author(s):  
Eduardo Martinez-del-Campo ◽  
Leonardo Rangel-Castilla ◽  
Hector Soriano-Baron ◽  
Nicholas Theodore
Keyword(s):  
Spinal Cord ◽  
Mr Imaging ◽  
Spinal Canal ◽  
English Language ◽  
Spinal Cord Injuries ◽  
Gunshot Wounds ◽  
Neurological Deficits ◽  
Neurological Improvement ◽  
Cord Injury

Object Performance of MR imaging in patients with gunshot wounds at or near the lumbar spinal canal is controversial. The authors reviewed the literature on the use of MR imaging in gunshot wounds to the spine. They discuss the results from in vitro and clinical studies, analyze the physical properties of common projectiles, and evaluate the safety and indications for MR imaging when metallic fragments are located near the spinal canal. Methods A review of the English-language literature was performed. Data from 25 articles were analyzed, including 5 in vitro studies of the interaction between 95 projectiles and the MR system's magnetic fields, and the clinical outcomes in 22 patients with metallic fragments at or near the spinal canal who underwent MR imaging. Results Properties of 95 civilian and military projectiles were analyzed at a magnet strength of 1, 1.5, 3, and 7 T. The most common projectiles were bullets with a core of lead, either with a copper jacket or unjacketed (73 [76.8%] of 95). Steel-containing (core or jacket) projectiles comprised 14.7%. No field interaction was evident in 78 (96.3%) of the 81 nonsteel projectiles. All steel projectiles showed at least positive deflection forces, longitudinal migration, or rotation. Heating of the projectiles was clinically insignificant. Image artifact was significant in all 9 steel bullets tested, but was not significant in 39 (88.6%) of the 44 nonsteel bullets tested. Overall, 22 patients with complete (82%) and incomplete (14%) spinal cord injury secondary to a projectile lodged inside the spinal canal underwent MR imaging. Discomfort and further physical or neurological deficits were not reported by any patient. Two patients with spinal cord injuries underwent MR imaging studies before surgical decompression and had subsequent, significant neurological improvement. Conclusions Metallic implants near or at the spinal canal are a relative contraindication for MR imaging. However, safe MR imaging might be feasible when a projectile's properties and a patient's individualized clinical presentation are considered.

scholarly journals Late presentation of spinal cord compression in hereditary multiple exostosis: case reports and review of the literature

2019 ◽  
Vol 13 (5) ◽  
pp. 463-470
Author(s):  
R. Gigi ◽  
B. T. Kurian ◽  
A. Cole ◽  
J. A. Fernandes
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Case Reports ◽  
Correct Diagnosis ◽  
Cord Compression ◽  
Late Presentation ◽  
Level Of Evidence ◽  
Hereditary Multiple Exostoses ◽  
Clear Cut ◽  
Cord Injury

Introduction Osteochondromas are usually found in the long bones of patients with hereditary multiple exostoses (HME). The spine is reported to be involved in over 50% of cases, but few of these patients are symptomatic as the result of an existing spinal exostosis. Methods We reviewed the current literature in order to find the right approach to patients with HME-complicated spinal exostosis and describe three paediatric patients that were diagnosed late with spinal cord compression due to cervical exostosis. Results Our three cases were all late presentations with neurology and unfortunately had minimal improvement of neurology after the lesion was surgically removed. There is general agreement that late presentation of spinal cord injury due to osteochondromas involving the cervical spine may cause severe and irreversible neurological sequelae. Our literature review revealed that there are no clear-cut guidelines to develop more comprehensive screening measures for these patients. Conclusions A high index of suspicion is the most important factor for correct diagnosis and appropriate management. Physicians who treat HME should bear in mind that thorough history taking and a neurological examination at follow up are essential for these patients. Clearer guidelines for the development of more comprehensive screening programmes are essential. Level of evidence IV

scholarly journals Recommendations for Publishing Case Studies of Cell Transplantation for Spinal Cord Injury

2010 ◽  
Vol 24 (8) ◽  
pp. 687-691 ◽  
Author(s):  
Bruce H. Dobkin
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
English Language ◽  
Cellular Therapy ◽  
Human Subjects ◽  
Case Reports ◽  
Case Series ◽  
Data Monitoring Committee ◽  
Fetal Tissue ◽  
Cord Injury

Background. Cellular transplantation for subacute and chronic spinal cord injury (SCI) continues to proceed around the world, but clinicians and patients have only 10 English language publications of case reports and self-serving Web page anecdotes to guide them. Methods. Recent publications about the use of olfactory ensheathing, bone marrow stromal, and fetal tissue stem cells in human subjects are examined to assess the adequacy of their designs, conclusions, and interpretation. Results. Case series reports to date reveal adverse responses to cellular therapy when clinicians look for these and no clear functional effects when a matched group that is not treated is compared. Rehabilitation that focuses on potential targets for sensorimotor and functional gains must precede a transplantation until a plateau of change is reached and then continue for at least 6 months if not a year. Conclusion. Criteria are listed as the minimum requirements for any further case series reports to be considered by journals in regard to cellular interventions for SCI. Based on available reports, the published interventions should not be given to additional patients. One or two of the strategies can be considered for testing in a randomized trial with blinded assessors and an independent data monitoring committee to examine for biological activity in patients with motor complete SCI of greater than 4 to 6 months duration.

scholarly journals Review of clinical neurorestorative strategies for spinal cord injury: Exploring history and latest progresses

2018 ◽  
Vol 1 (1) ◽  
pp. 171-178 ◽  
Author(s):  
Hongyun Huang ◽  
Hari Shanker Sharma ◽  
Lin Chen ◽  
Ali Otom ◽  
Ziad M. Al Zoubi ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
English Language ◽  
Academic Community ◽  
Placebo Control ◽  
Level Of Evidence ◽  
Double Blind ◽  
Historical Perspectives ◽  
Cord Injury ◽  
Google Search

Clinical neurorestorative therapies recently made great progress for patients with spinal cord injury (SCI). This paper systemically reviews historical perspectives, recent advancements and achievements in SCI through key neurorestorative strategies. In this study, a search was performed in the PubMed, Scopus, and Scholar Google search engines using the keywords “neurorestorative strategies”, “spinal cord injury”, “cell therapy”, “neuromodulation”, and “nerve bridges”. Clinical studies published in the English language were included. It is paramount for academic community involved in this field to take the initiative of a multicenter randomized, double-blind, and placebo-control clinical study with high level of evidence-based treatments for most SCI neurorestorative strategies in patient management. It is of utmost need to establish standard therapeutic methods for patients with SCI as early as possible.

Impairment Rating and Spinal Cord Injuries: Revisiting the Guides

2010 ◽  
Vol 15 (3) ◽  
pp. 1-7
Author(s):  
Richard T. Katz
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injuries ◽  
Functional Independence ◽  
Outcome Data ◽  
Multiple Organ ◽  
Loss Of Function ◽  
Sixth Edition ◽  
Organ Systems ◽  
Cord Injury ◽  
Impairment Ratings

Abstract This article addresses some criticisms of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) by comparing previously published outcome data from a group of complete spinal cord injury (SCI) persons with impairment ratings for a corresponding level of injury calculated using the AMA Guides, Sixth Edition. Results of the comparison show that impairment ratings using the sixth edition scale poorly with the level of impairments of activities of daily living (ADL) in SCI patients as assessed by the Functional Independence Measure (FIM) motor scale and the extended FIM motor scale. Because of the combinations of multiple impairments, the AMA Guides potentially overrates the impairment of paraplegics compared with that of quadriplegics. The use and applicability of the Combined Values formula should be further investigated, and complete loss of function of two upper extremities seems consistent with levels of quadriplegia using the SCI model. Some aspects of the AMA Guides contain inconsistencies. The concept of diminishing impairment values is not easily translated between specific losses of function per organ system and “overall” loss of ADLs involving multiple organ systems, and the notion of “catastrophic thresholds” involving multiple organ systems may support the understanding that variations in rating may exist in higher rating cases such as those that involve an SCI.

scholarly journals Dietary Supplementation for Para-Athletes: A Systematic Review

Nutrients ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 2016
Author(s):  
Keely A. Shaw ◽  
Gordon A. Zello ◽  
Brian Bandy ◽  
Jongbum Ko ◽  
Leandy Bertrand ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Dietary Supplements ◽  
Sports Medicine ◽  
Spinal Cord Injuries ◽  
Sport Performance ◽  
Future Research ◽  
Inclusion Criteria ◽  
Supplement Use ◽  
Sport Supplements ◽  
Cord Injury

The use of dietary supplements is high among athletes and non-athletes alike, as well as able-bodied individuals and those with impairments. However, evidence is lacking in the use of dietary supplements for sport performance in a para-athlete population (e.g., those training for the Paralympics or similar competition). Our objective was to examine the literature regarding evidence for various sport supplements in a para-athlete population. A comprehensive literature search was conducted using PubMed, SPORTDiscus, MedLine, and Rehabilitation and Sports Medicine Source. Fifteen studies met our inclusion criteria and were included in our review. Seven varieties of supplements were investigated in the studies reviewed, including caffeine, creatine, buffering agents, fish oil, leucine, and vitamin D. The evidence for each of these supplements remains inconclusive, with varying results between studies. Limitations of research in this area include the heterogeneity of the subjects within the population regarding functionality and impairment. Very few studies included individuals with impairments other than spinal cord injury. Overall, more research is needed to strengthen the evidence for or against supplement use in para-athletes. Future research is also recommended on performance in para-athlete populations with classifiable impairments other than spinal cord injuries.

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