scholarly journals Contemporary management and outcome of myelomeningocele: the Rotterdam experience

2019 ◽  
Vol 47 (4) ◽  
pp. E3 ◽  
Author(s):  
Jochem K. H. Spoor ◽  
Pravesh S. Gadjradj ◽  
Alex J. Eggink ◽  
Philip L. J. DeKoninck ◽  
Bart Lutters ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Fetal Surgery ◽  
Standard Of Care ◽  
Reoperation Rate ◽  
Outcome Data ◽  
Experimental Therapy ◽  
Decompression Surgery ◽  
Tethered Spinal Cord ◽  
Historical Cohort ◽  
Select Group

OBJECTIVEMyelomeningocele (MMC) is the most common form of spina bifida, with a lifelong impact on the quality of life for infants born with this condition. In recent decades, fetal surgery has evolved from an experimental therapy to standard of care for many centers in the world. In this study, the authors aimed to provide an overview of the current management and outcomes for infants with MMC managed at their institution. This then provides a center-specific historical cohort for comparison with future antenatal-treated MMC cases.METHODSThis is a retrospective, single-institution cohort study including all consecutive MMC cases between January 1, 2000, and June 1, 2018, at Erasmus MC. Outcome data included closure of the defect (location, timing, and surgical parameters), hydrocephalus management, Chiari malformation type II (CMTII) management, incidence of spinal cord tethering and outcome, motor outcomes, and continence.RESULTSA total of 93 patients were included with predominantly lumbosacral lesions. Two patients died during follow-up. Hydrocephalus was present in 84%, with a 71% ventriculoperitoneal shunt reoperation rate. Surgery was performed in 12% for a tethered spinal cord at a mean age of 8 years. Decompression surgery was performed in 3 patients for CMTII. Special education in 63% was significantly associated with hydrocephalus (p < 0.015). Nineteen percent of patients were able to walk independently, and 47% were nonambulators. Social continence for urine was obtained in 75% of patients, 4% had fecal incontinence.CONCLUSIONSThis study provides an overview of current MMC outcomes at the authors’ center and will serve as a historical cohort for comparison with future fetal surgery cases operated on at the center in the coming years. Apart from a relatively low surgical untethering rate, the authors’ outcome data are comparable to those in the literature. Hydrocephalus is highly prevalent in postnatally treated MMC patients; in this study as in much of the literature, hydrocephalus is correlated with a low cognitive function. Fetal surgery for MMC halves the need for shunt treatment in a select group of MMC pregnancies, constituting a major indication for us to undergo the transition to a fetal surgery center. The fetal benefits of open antenatal surgery for MMC are well established, yet long-term data on especially tethered spinal cord are eagerly awaited.

Surgical management of the tethered spinal cord—walking the fine line

2007 ◽  
Vol 23 (2) ◽  
pp. E4 ◽  
Author(s):  
James M. Drake
Keyword(s):  
Spinal Cord ◽  
Treatment Strategies ◽  
Treatment Decision ◽  
Outcome Data ◽  
General Category ◽  
Tethered Spinal Cord ◽  
High Quality ◽  
Fine Line ◽  
Case Examples ◽  
Clinical Presentations

✓The tethered spinal cord is a fascinating yet controversial condition seen frequently in neurosurgical practice. Treatment decision making is made difficult by the variety of lesions and clinical presentations comprised by this condition and the absence of high-quality clinical outcome data to provide guidance. Clinical presentations may be divided into four general categories or typical scenarios: 1) significant dysraphic abnormality, clear clinical deterioration; 2) significant dysraphic abnormality, clinically normal or stable deficit; 3) incidentally discovered abnormality, other problem; and 4) tethered spinal cord symptomatology, normal imaging. The author provides case examples to illustrate potential treatment approaches and suggests balancing the risks and benefits for each general category. Clearer diagnostic and treatment strategies for the tethered spinal cord will only result from high-quality clinical and basic research. Until the results of such research are available, surgeons should endeavor to maximize benefit and reduce risk for patients who may have a tethered spinal cord, walking the fine line between over- and undertreatment.

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 1758. Impact of Accelerate Pheno™ Rapid Blood Culture Detection System on Laboratory and Clinical Outcomes in Bacteremic Patients

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S61-S61 ◽  
Author(s):  
Ryan Dare ◽  
Kelsey McCain ◽  
Katherine Lusardi ◽  
Kay Daniels ◽  
Jacob Painter ◽  
...  
Keyword(s):  
Blood Culture ◽  
Clinical Outcomes ◽  
Bacterial Infections ◽  
Detection System ◽  
Positive Culture ◽  
Retrospective Chart Review ◽  
Improve Patient Care ◽  
Standard Of Care ◽  
Historical Cohort ◽  
Stewardship Program

Abstract Background Molecular-based automated systems for the rapid diagnosis of bacterial infections have potential to improve patient care. The Accelerate Pheno™ blood culture detection system (ACCEL) is an FDA approved platform that allows for identification (ID) and antimicrobial susceptibility testing (AST) 8 hours following growth in routine culture. Methods This is a single-center retrospective chart review of bacteremic adult inpatients before and after implementation of ACCEL. Laboratory and clinical data were collected February–March 2018 (intervention) and compared with a January–April 2017 historical cohort (standard of care). Standard of care ID and AST were performed using VITEK® MS (MALDI-TOF MS) and VITEK®2, respectively. An active antimicrobial stewardship program was in place during both study periods. Patients with polymicrobial cultures, off-panel isolates, previous positive culture, or who were discharged prior to final AST report were excluded. Primary outcome was length of stay (LOS). Secondary outcomes were inpatient antibiotic duration of therapy (DOT) and time to optimal therapy (TTOT). Nonparametric unadjusted analyses were performed due to non-normal distributions. Statistics were performed using SAS 9.4. Results Of the 143 positive cultures performed on ACCEL during intervention, 118 (83%) were identified as on-panel organisms. Seventy-five (64%) of these 118 cultures and 79 (70%) of 113 reviewed standard of care cultures met inclusion criteria. Patient comorbidities (P = NS), MEWS severity score (P = 0.10), source of bacteremia (P = NS), and pathogen detected (P = 0.30) were similar between cohorts. Time from collection to ID (28.2 ± 12.7 hours vs. 53.8 ± 20.9 hours; P &lt; 0.001) and AST (31.9 ± 11 hours vs. 71.8 ± 20 hours; P &lt; 0.001) were shorter in the intervention arm. Conclusion Compared with standard of care, ACCEL shortens laboratory turn-around-time and improves clinical outcomes. The use of this system has resulted in decreased mean antibiotic DOT, TTOT, and LOS. Further studies are needed to verify these findings. Disclosures All authors: No reported disclosures.

scholarly journals Inhibition of Glycine Re-Uptake: A Potential Approach for Treating Pain by Augmenting Glycine-Mediated Spinal Neurotransmission and Blunting Central Nociceptive Signaling

Biomolecules ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 864
Author(s):  
Christopher L. Cioffi
Keyword(s):  
Spinal Cord ◽  
Dorsal Horn ◽  
Therapeutic Potential ◽  
Opioid Analgesic ◽  
Critical Role ◽  
Analgesic Efficacy ◽  
Standard Of Care ◽  
Current Standard ◽  
Glycine Transporters ◽  
Pathological Pain

Among the myriad of cellular and molecular processes identified as contributing to pathological pain, disinhibition of spinal cord nociceptive signaling to higher cortical centers plays a critical role. Importantly, evidence suggests that impaired glycinergic neurotransmission develops in the dorsal horn of the spinal cord in inflammatory and neuropathic pain models and is a key maladaptive mechanism causing mechanical hyperalgesia and allodynia. Thus, it has been hypothesized that pharmacological agents capable of augmenting glycinergic tone within the dorsal horn may be able to blunt or block aberrant nociceptor signaling to the brain and serve as a novel class of analgesics for various pathological pain states. Indeed, drugs that enhance dysfunctional glycinergic transmission, and in particular inhibitors of the glycine transporters (GlyT1 and GlyT2), are generating widespread interest as a potential class of novel analgesics. The GlyTs are Na+/Cl−-dependent transporters of the solute carrier 6 (SLC6) family and it has been proposed that the inhibition of them presents a possible mechanism by which to increase spinal extracellular glycine concentrations and enhance GlyR-mediated inhibitory neurotransmission in the dorsal horn. Various inhibitors of both GlyT1 and GlyT2 have demonstrated broad analgesic efficacy in several preclinical models of acute and chronic pain, providing promise for the approach to deliver a first-in-class non-opioid analgesic with a mechanism of action differentiated from current standard of care. This review will highlight the therapeutic potential of GlyT inhibitors as a novel class of analgesics, present recent advances reported for the field, and discuss the key challenges associated with the development of a GlyT inhibitor into a safe and effective agent to treat pain.

Vertebral fractures and luxations in dogs and cats part 2: treatment and surgery options

2021 ◽  
Vol 26 (3) ◽  
pp. 15-19
Author(s):  
Ivona Orgonikova ◽  
Josep Brocal ◽  
Giunio Bruto Cherubini ◽  
Viktor Palus
Keyword(s):  
Spinal Cord ◽  
Vertebral Fractures ◽  
Vertebral Column ◽  
Compartment Model ◽  
Spinal Instability ◽  
Decompression Surgery ◽  
Implant Loosening ◽  
Bone Fragment ◽  
Three Compartment Model ◽  
Disc Extrusion

Assessing the presence of vertebral column instability is essential in animals with vertebral fractures or luxations. Spinal instability is most commonly assessed using a three-compartment model and unstable vertebral fractures and luxations require surgical stabilisation. In cases of compression of the spinal cord (by haematoma, traumatic intervertebral disc extrusion or bone fragment), decompression surgery is necessary. Prompt surgery prevents additional spinal cord damage, but the overall condition of the patient, including any concurrent injuries, needs to be continually kept in mind. The vertebral column can be stabilised using multiple techniques, such as screws, pins, polymethylmetacrylate and plating techniques, as well as external stabilisation and spinal stapling. Complications of spinal surgeries include haemorrhage, infection, neurological deterioration, particularly in cases of spinal stabilisations, implant loosening and failure.

scholarly journals Statin use is associated with reduced motor recovery after spinal cord injury

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Erin M. Triplet ◽  
Isobel A. Scarisbrick
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Motor Recovery ◽  
Motor Deficit ◽  
Historical Cohort ◽  
Cholesterol Lowering ◽  
Severity Of Injury ◽  
Cord Injury ◽  
The Impact ◽  
Statin Use

Abstract Study design We completed retrospective analysis of statin use in individuals with neurologically significant spinal cord injury in a historical cohort study. Objective Our objective was to establish the prevalence of cholesterol-lowering agent use following spinal cord injury (SCI) and to determine the impact on recovery of motor function. Setting Patients enrolled in the Rochester Epidemiology Project in Olmsted County, Minnesota, USA from 2005 to 2018 were included in analysis. Methods Exclusion criteria: age <18, comorbid neurological disease, prior neurological deficit, nontraumatic injury, survival <1 year, or lack of motor deficit. Demographics and cholesterol-lowering agent use in 83 individuals meeting all criteria were recorded. A total of 68/83 individuals were then assessed for change in function over the first 2 months after injury using the ISNCSCI motor subscore. Statistical comparison between control and statin groups was done by two-sided Chi-squared test or two-tailed Student’s t test. Generalized regression was performed to assess associations between independent variables and functional outcome. Results 30% of individuals with SCI had a prescription for a cholesterol-lowering agent. No significant differences were observed in severity of injury or demographic composition between groups. The change in motor subscore was reduced in the statin group compared to controls (p = 0.03, Mann–Whitney). Both severity of injury and statin were significant predictors of reduced motor recovery (p = 0.001, and p = 0.04, respectively). Conclusions Both severity of SCI and statins were significant predictors of reduced motor recovery. Additional investigation is needed to address potential impact of statin-therapy in the context of CNS injury and repair.

Axonal Transport of Horseradish Peroxidase in the Experimental Tethered Spinal Cord

1989 ◽  
Vol 15 (6) ◽  
pp. 296-301 ◽  
Author(s):  
Takaharu Fuse ◽  
John W. Patrickson ◽  
Shokei Yamada
Keyword(s):  
Spinal Cord ◽  
Horseradish Peroxidase ◽  
Axonal Transport ◽  
Tethered Spinal Cord

Spine-shortening vertebral osteotomy in a patient with tethered cord syndrome and a vertebral fracture

2008 ◽  
Vol 9 (1) ◽  
pp. 62-66 ◽  
Author(s):  
Haruo Kanno ◽  
Toshimi Aizawa ◽  
Hiroshi Ozawa ◽  
Takeshi Hoshikawa ◽  
Eiji Itoi ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Vertebral Fracture ◽  
Rare Case ◽  
Tethered Cord ◽  
Conus Medullaris ◽  
Tethered Cord Syndrome ◽  
Bone Union ◽  
Tethered Spinal Cord ◽  
Fracture Fragment ◽  
Loss Of Correction

The authors report a rare case of tethered cord syndrome with low-placed conus medullaris complicated by a vertebral fracture that was successfully treated by a spine-shortening vertebral osteotomy. The patient was a 57-year-old woman whose neurological condition worsened after a T-12 vertebral fracture because a fracture fragment and the associated local kyphotic deformity directly compressed the tethered spinal cord. An osteotomy of the T-12 vertebra was performed in order to correct the kyphosis, remove the fracture fragment, and reduce the tension on the spinal cord. Postoperative radiographs showed the spine to be shortened by 22 mm, and the kyphosis between T-11 and L-1 improved from 23° to 0°. Two years after the surgery, the patient's neurological symptoms were resolved. The bone union was complete with no loss of correction.

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