The value of quantitative diffusion tensor imaging indices of spinal cord disorders

Background Different lesions affecting the spinal cord can lead to myelopathy. Diffusion tensor imaging (DTI) is widely used to predict the degree of spinal cord microstructure affection and to assess axonal integrity and diffusion directionality. We hypothesized that not all DTI parameters have the same affection with different spinal cord pathologies. The purpose of this study is to assess the value of the quantitative diffusion tensor imaging indices in different spinal cord lesions. Results There is highly statistically significant difference of the fractional anisotropy (FA), relative anisotropy (RA), volume ratio (VR) and secondary eigenvector values (E2 and E3) between various studied cord lesions and control levels. There is no statistically significant difference of the apparent diffusion coefficient (ADC) and the primary eigenvector value (E1) (ANOVA test). The ROC curve analysis showed the higher sensitivity and accuracy were ‘88% and 62.5%, respectively,’ with FA cutoff value about 0.380. Conclusion The resulted quantitative DTI indices ‘fractional anisotropy, relative anisotropy, volume ratio and secondary eigenvalues’ work as a numerical in vivo marker of overall tissue injury in different pathologies affecting the spinal cord.

Evaluation and Management of Acute Myelopathy

Acute myelopathies are spinal cord disorders characterized by a rapidly progressive course reaching nadir within hours to a few weeks that may result in severe disability. The multitude of underlying etiologies, complexities in confirming the diagnosis, and often unforgiving nature of spinal cord damage have always represented a challenge. Moreover, certain slowly progressive myelopathies may present acutely or show abrupt worsening in specific settings and thus further complicate the diagnostic workup. Awareness of the clinical and magnetic resonance imaging characteristics of different myelopathies and the specific settings where they occur is fundamental for a correct diagnosis. Neuroimaging helps distinguish compressive etiologies that may require urgent surgery from intrinsic etiologies that generally require medical treatment. Differentiation between various myelopathies is essential to establish timely and appropriate treatment and avoid harm from unnecessary procedures. This article reviews the contemporary spectrum of acute myelopathy etiologies and provides guidance for diagnosis and management.

Low-Level Laser Therapy Techniques and Equipment for Occupational Disease Prevention in Precision Workers

Background: The problem of protecting and maintaining health of workers in the microelectronics industry exposed to adverse occupational factors including tension and overstrain of the muscles of the upper extremities and visual strain, gains special relevance. Objective: Introduction of the developed and patented low-level laser therapy techniques to recover functions of vision and the musculoskeletal system impaired in the course of work. Materials and methods: The study involved 65 chip assemblers aged 26–41 years. Their eyes, the back of the hands, and the collar area were exposed to low-level laser radiation from the red region of the spectrum. All employees were examined by a neurologist and a surgeon and their working conditions were evaluated. The accommodation apparatus was tested using an AKA-01 type accommodation meter. Results: After five 10-minute sessions, we registered an increase in the volume of absolute accommodation during the observation period before and after the work shift by 28 % and 19 %, respectively. On subsequent days of observation, we noted an increase in the accommodation during 10 days, followed by a decrease by the 30th day of observation. Application of preventive techniques helped eliminate spinal cord disorders in all workers. Blood circulation in fingers increased by 66 % compared to the initial condition. Discussion: Low-level laser therapy improves blood supply, intensifies redox processes in the retina of the eye, skin cells, and blood vessels. Conclusions: Low-level laser radiation of the red region of the spectrum relieves the spasm of accommodation and normalizes the efficiency of the accommodation apparatus. Such laser therapy helps eliminate spinal cord disorders and improve blood circulation. Introduction of the developed techniques can prevent occupational diseases and reduce disability in patients.

Delivering Precision Medicine to Patients with Spinal Cord Disorders; Insights into Applications of Bioinformatics and Machine Learning from Studies of Degenerative Cervical Myelopathy

With the common adoption of electronic health records and new technologies capable of producing an unprecedented scale of data, a shift must occur in how we practice medicine in order to utilize these resources. We are entering an era in which the capacity of even the most clever human doctor simply is insufficient. As such, realizing “personalized” or “precision” medicine requires new methods that can leverage the massive amounts of data now available. Machine learning techniques provide one important toolkit in this venture, as they are fundamentally designed to deal with (and, in fact, benefit from) massive datasets. The clinical applications for such machine learning systems are still in their infancy, however, and the field of medicine presents a unique set of design considerations. In this chapter, we will walk through how we selected and adjusted the “Progressive Learning framework” to account for these considerations in the case of Degenerative Cervical Myeolopathy. We additionally compare a model designed with these techniques to similar static models run in “perfect world” scenarios (free of the clinical issues address), and we use simulated clinical data acquisition scenarios to demonstrate the advantages of our machine learning approach in providing personalized diagnoses.

Vascular Spinal Cord Disorders

Vascular disorders of the spinal cord are uncommon yet under-recognized causes of myelopathy. Etiologies can be predominantly categorized into clinical and radiographic presentations of arterial ischemia, venous congestion/ischemia, hematomyelia, and extraparenchymal hemorrhage. While vascular myelopathies often produce significant morbidity, recent advances in the understanding and recognition of these disorders should continue to expedite diagnosis and proper management, and ideally improve patient outcomes. This article comprehensively reviews relevant spinal cord vascular anatomy, clinical features, radiographic findings, treatment, and prognosis of vascular disorders of the spinal cord.

Traumatic Spinal Cord Disorders: Current Topics and Future Directions

Traumatic spinal cord injury (tSCI) is a life-changing and potentially overwhelming event. The sudden disruption of the spinal cord's integrity necessitates rapid attention at a specialized medical center, and involves a multilateral collaboration between neurologists, spine surgeons, critical care physicians, and trauma specialists. Even with care under ideal conditions, many tSCI patients have significant disability that persists for the rest of their lives. However, recently, we have seen a proliferation in clinical and translational trials that offer the promise that new treatments may be available soon.

Scales for Spinal Cord Disorders

Clinical scales are important tools for quantitatively evaluating impairments and disabilities related to diseases. Clinical scales are also used in many clinical studies to assess therapeutic effects. Spinal cord disorders cause neurological deterioration, which leads to functional and social disabilities. For many neurological disorders that cause myelopathy, including multiple sclerosis and other inflammatory demyelinating diseases, numerous drugs are being developed and studied for clinical use. Thus, clinical scales for myelopathy are important for both the medical field and general public. This review article describes the clinical scales for myelopathy, especially those that are widely used and established. We expect that this review will help readers choose the scales appropriate for their purposes.