Identification of Risk and Prognostic Factors for Transverse Myelitis in Systemic Lupus Erythematosus

Purpose: Our aim in this study was to describe the clinical characteristics and outcomes of patients with transverse myelitis (TM) as a rare phenotype of systemic lupus erythematosus (SLE) and to identify the risk and prognostic factors for SLE-related TM.Methods: The analysis was based on 58 patients with SLE-related TM admitted to Peking Union Medical College Hospital between January 1993 and May 2021.The control group included 101 patients, randomly selected from our SLE patient group, without TM, using propensity score matching for age at SLE diagnosis, sex, and SLE disease course. Conditional logistic regression and Cox proportional hazard regression were used to identify risk and prognostic factors for SLE-related TM. Results: Multivariate analysis revealed that anti-SSA(p<0.001) and anti-RNP positivity (p=0.005) were independent risk factors for SLE-related TM. With regard to prognosis, an American Spinal Injury Association Impairment Scale (AIS) grade of A or B at the early stage of TM (p<0.001) and hypoglycorrhachia (p=0.016) were independent risk factors for unfavourable neurological outcomes. In regard to neurological recovery at 3 months, an American Spinal Injury Association Impairment Scale (AIS) grade of A, B, or C at the early stage of TM was the only prognostic factor for SLE-related TM (hazard ratio, 0.26; 95% confidence interval, 0.08-0.91; p=0.035). Conclusions: Anti-SSA and anti-RNP positivity were independent risk factors for TM in patients with SLE. Initial severe myelitis and hypolycorrhachia are predictive of a poor prognosis. Glucocorticoid pulse therapy provided within 2 weeks of TM onset may improve TM prognosis. Understanding the risk and prognostic factors of TM is important as permanent neurological disability persists in a significant proportion of patients with SLE-related TM.

Eficácia da biópsia vertebral percutânea guiada por fluoroscopia

Resumo Objetivo Definir a eficácia da biópsia vertebral percutânea guiada por fluoroscopia. Métodos Este é um estudo prospectivo de pacientes com síndrome de destruição vertebral em uma instituição. Os pacientes foram submetidos a biópsias vertebrais transpediculares percutâneas guiadas por fluoroscopia, com obtenção de tecido ósseo e tecido do disco intervertebral, para estudo histopatológico e microbiológico. Idade, sexo, segmento vertebral, estado neurológico, e resultados de biópsia e de cultura foram analisados. Resultados A idade média dos pacientes foi de 53,8 anos (gama: 2 a 83 anos), e o principal local acometido da coluna foi a segmento lombar, em 62% dos casos. Segundo a escala de disfunção da American Spinal Injury Association (ASIA), no pré-operatório, 49% dos pacientes foram classificados como ASIA E, e 100% apresentavam dor. A etiologia definitiva foi identificada em 83% dos pacientes. A etiologia foi agrupada em três categorias: infecciosa, neoplásica, e degenerativa (osteoporótica). O grupo infeccioso era composto por 36% dos pacientes da amostra, e Staphylococcus aureus foi o agente mais comumente identificado; em 34,9% dos casos, a etiologia era neoplásica, principalmente mieloma múltiplo e doença metastática por câncer de próstata; 21,7% dos pacientes apresentavam osteoporose. O tempo cirúrgico médio foi de 47,5 minutos, e a perda média de sangue foi de 10 mL. Nenhuma complicação foi relatada. Conclusão Nesta série, a biópsia percutânea transpedicular guiada por fluoroscopia teve 83% de eficácia no diagnóstico etiológico da síndrome de destruição vertebral. Este procedimento minimamente invasivo deve ser considerado bom, fácil, barato e reprodutível, com baixo risco de complicações em curto e longo prazos.

Adult Spinal Cord Injury without Major Bone Injury: Effects of Surgical Decompression and Predictors of Neurological Outcomes in American Spinal Injury Association Impairment Scale A, B, or C

The cervical spine can be injured even in the absence of radiographic abnormality, and the best surgical treatment for adult spinal cord injury without bone injury is debated. The aim of this study was to retrospectively investigate the effect of surgical decompression for severe adult spinal cord injury without major bone injury and to establish predictors of good neurological outcome. We analyzed 11 patients who underwent surgical decompression in severe adult spinal cord injury without major bone injury patients classified as American Spinal Injury Association Impairment Scale (AIS) grade A, B, or C. Neurological assessments were performed using AIS at preoperative and postoperative 1-year follow-up. Radiological evaluations were performed using cervical magnetic resonance imaging (MRI) at preoperative. Seven cases were classified as AIS grade A; two cases as AIS grade B; and two cases as AIS grade C. Five of 11 (45.5%) patients showed improved neurological grade 1-year postoperatively. Intramedullary lesion length (IMLL) (p = 0.047) and compression rate (p = 0.045) had the most powerful effect on AIS grade conversion. This study shows that the fate of the injured spinal cord is determined at the time of the injury, but adequate decompression may have limited contribution to the recovery of neurological function. Compression rate and IMLL on MRI can be used as a predictor of neurological recovery.

Bilateral isolated C5 paralysis of the shoulder: Atypical presentation of a transdiscal C4-C5 cervical spine fracture

After a low-energy fall, an 83-year-old man presented with bilateral weakness of the upper arms without loss of sensation associated with a rigid cervical spine (ankylosing spinal disorder, ASD). Because of an atypical presentation during history, examination and initial imaging, a late diagnosis of a transdiscal C4-C5 fracture was made by dynamic radiographs. Anterior cervical discectomy and fusion were performed with delay. Strength improved from grade C to D (American Spinal Injury Association classification) after surgery. To our knowledge, this is the first description of a bilateral, isolated upper limb C5 paralysis without any loss of sensation caused by a transdiscal C4-C5 fracture. A high clinical and diagnostic index of suspicion is mandatory to make the diagnosis. We present three clinical ‘Awareness Criteria’ (1: recognition of ASD; 2: high index of fracture suspicion; 3: necessary imaging) helping clinicians to safely and promptly diagnose occult spinal fractures in ASD.

The Outcome of Subaxial Cervical Injury in Adult Patients Managed Surgically Through an Anterior Approach

Objectives: We determined the Outcome of subaxial cervical injury management in adults through anterior approach open reduction and fixation injury < 72 hours. Material and Methods: A total of 71 patients declared to have a recent chronicle of traumatic cervical spine injury with a conventional diagnosis of subaxial injury by Magnetic Resonance Imaging (MRI) and X-Ray anteroposterior and lateral views. ASIA Impairment Scale was used for assessment and was done at the time of admission and after six months. Results: Mean age of the patients in our study was 38.54 ± 5.47 years. According to American Spinal Injury Association (ASIA) scale, improvement by two grades was seen in 18 cases and improvement by one – grade was observed in 48 cases. Mortality was seen in 5 cases, where 2 deaths were related to associated injury, one related to a complication of surgery and other 2 died due to aspiration complications. Out of 66 cases, the outcome was good in 49 (74.29%) and fair in 17 (25.76%). Conclusion: The study results revealed that Anterior Cervical Discectomy and Fusion (ACDF) is considered to be a better treatment choice for better anatomical stabilization of the spine with early reduction. Keywords: Subaxial cervical injury, anterior approach, ASIA (American Spinal Injury Association) scoring.