Neuroaxial anesthesia caused paraplegia: a case report

Patients who undergo; anesthesia, neuraxial analgesia, or some type of neuraxial blockage are exposed to multiple complications. 33-year-old male patient, suffers a femur fracture with a long oblique trace causing pain and functional limitation for movements. Surgical resolution is determined using neuraxial block at L2-L3 level, and intravenous sedation. During his postoperative follow-up, a decrease in strength was confirmed in the lower limbs with 0/5 on the Daniels scale, 100% sensitivity without sphincter control, steroids were prescribed along with magnetic resonance imaging and a neurosurgical evaluation was requested. The MRI shows bulging of the fibrous annulus that obliterates the epidural fat and makes contact with the thecal sac in the L5-S1 intervertebral disc level. The neurosurgery service prescribes rehabilitation sessions at home, electrostimulation and neuropathic medications. Patient was discharged with rehabilitation sessions at home and medical treatment. In his last consultation, an evaluation from the psychiatry department was requested for ideas of disability, hopelessness, fantasies of death without a suicide plan related to limitations and loss of functionality. Patient does not return to external follow-up, cannot be located.

Reconstruction of Epidural Fat to Prevent Epidural Fibrosis after Laminectomy in Rabbits

Background: Laminectomy can effectively decompress the spinal cord and expand the vertebral canal. However, the fibrosis that appears may cause adherence and recompression of the spinal cord or/ and nerve root, which may cause Failed Back Syndrome (FBS) and make the re-exposure process more difficult. Reconstruction of the epidural fat may be an ideal method to achieve satisfactory results. Methods: Thirty-six New Zealand rabbits were randomly divided into three groups: control, ECM, and ECM+aMSCs groups. Saline, ECM gel, and ECM+aMSC complex were placed respectively at the fifth lumbar vertebrate of the rabbits. Epidural fat and fibrosis formation were detected by MRI and histologically at the 4th, 8th, and 12th weeks. Quantitative RT-PCR was used to detect the expression of IL-6 and TGF-β. Results: MRI and Oil Red O staining revealed epidural fat formation at the 12th week in the ECM+aMSCs group. H&E staining showed that the numbers of fibroblasts in the ECM gel and ECM+aMSCs groups were less than the control group at the 4th and 8th weeks (P<0.05). Masson’s trichrome staining showed that the proportion of collagen fibers in the ECM gel and ECM+aMSCs group was lower than the control group (P<0.05). Quantitative RT-PCR showed the expressions of TGF-β and IL-6 were lower in the ECM gel and ECM+aMSCs group than the control group (P<0.05) at the 4th week, but higher at the 8th week. Conclusion: We successfully reconstructed the epidural fat with ECM gel and aMSC complex; additionally, IL-6 and TGF-β cytokines were lower at early stage after laminectomy.

Comparisons of Extracellular Vesicles from Human Epidural Fat-Derived Mesenchymal Stem Cells and Fibroblast Cells

Extracellular vesicles (EVs) are generated and secreted by cells into the circulatory system. Stem cell-derived EVs have a therapeutic effect similar to that of stem cells and are considered an alternative method for cell therapy. Accordingly, research on the characteristics of EVs is emerging. EVs were isolated from human epidural fat-derived mesenchymal stem cells (MSCs) and human fibroblast culture media by ultracentrifugation. The characterization of EVs involved the typical evaluation of cluster of differentiation (CD antigens) marker expression by fluorescence-activated cell sorting, size analysis with dynamic laser scattering, and morphology analysis with transmission electron microscopy. Lastly, the secreted levels of cytokines and chemokines in EVs were determined by a cytokine assay. The isolated EVs had a typical size of approximately 30–200 nm, and the surface proteins CD9 and CD81 were expressed on human epidural fat MSCs and human fibroblast cells. The secreted levels of cytokines and chemokines were compared between human epidural fat MSC-derived EVs and human fibroblast-derived EVs. Human epidural fat MSC-derived EVs showed anti-inflammatory effects and promoted macrophage polarization. In this study, we demonstrated for the first time that human epidural fat MSC-derived EVs exhibit inflammatory suppressive potency relative to human fibroblast-derived EVs, which may be useful for the treatment of inflammation-related diseases.