Case Report: Identifying Andersson-Like Lesions in Diffuse Idiopathic Skeletal Hyperostosis

Andersson lesions (ALs) in ankylosing spondylitis (AS) pose a severe risk to the stability of ankylosed spine, which might result in significant deterioration of spinal cord function after traumatic or inflammatory causes. Herein, erosive discovertebral lesions in diffuse idiopathic skeletal hyperostosis (DISH) presented important clinical similarities to AL in AS, but failed to completely recognize unstable spinal lesions. Therefore, we pioneered to identify spinal discovertebral lesions similar to Andersson-like lesions (ALLs) in DISH, followed by the characterization and summarization of the etiology, radiology, laboratory results, clinical symptoms, and treatment strategies for AL in AS with ALL in DISH. By characterizing the ALL in DISH cases, we showed that the ALL was mainly traumatic and established at the junction of focal stress between two adjacent ossified level arms. Erosive discovertebral ALLs were formed after trivial stress of direct impact and could be subdivided into transdiscal, transvertebral, and discovertebral types radiologically. Patients who presented with ALL frequently suffered from consistent back pain clinically and experienced a decrease in motion ability that could reflect skeletal stability, which received treatment effectiveness after conservative external spinal immobilization or further surgical internal fixation, indicating the significance of recognizing ALL in the ankylosed DISH spine to further maintain spinal stability in order to prevent catastrophic neurologic sequelae. Our work highlighted the clinical relevance of ALL in DISH in comparison with AL in AS, which provided broader insight to identify ALL in DISH, thus facilitating early intervention against DISH deterioration.

Allografts for Skin Closure during In Utero Spina Bifida Repair in a Sheep Model

Objectives: Use of off-label tissue graft materials, such as acellular dermal matrix (ADM), for in utero repair of severe spina bifida (SB), where primary skin layer closure is not possible, is associated with poor neurological outcomes. The cryopreserved human umbilical cord (HUC) patch has regenerative, anti-inflammatory, and anti-scarring properties, and provides watertight SB repair. We tested the hypothesis that the HUC is a superior skin patch to ADM for reducing inflammation at the repair site and preserving spinal cord function. Methods: In timed-pregnant ewes with twins, on gestational day (GD) 75, spina bifida was created without a myelotomy (functional model). On GD 95, repair was performed using HUC vs. ADM patches (randomly assigned) by suturing them to the skin edges. Additionally, full thickness skin closure as a primary skin closure (PSC) served as a positive control. Delivery was performed on GD 140, followed by blinded to treatment neurological assessments of the lambs using the Texas Spinal Cord Injury Scale (TSCIS) for gait, proprioception, and nociception. Lambs without spina bifida were used as controls (CTL). Ex vivo magnetic resonance imaging of spines at the repair site were performed, followed by quantitative pathological assessments. Histological assessments (blinded) included Masson’s trichrome, and immunofluorescence for myeloperoxidase (MPO; neutrophils) and for reactive astrocytes (inflammation) by co-staining vimentin and GFAP. Results: The combined hind limbs’ TSCIS was significantly higher in the HUC group than in ADM and PSC groups, p = 0.007. Both ADM and PSC groups exhibited loss of proprioception and mild to moderate ataxia compared to controls. MRI showed increased pathological findings in the PSC group when compared to the HUC group, p = 0.045. Histologically, the meningeal layer was thickened (inflammation) by 2–3 fold in ADM and PSC groups when compared to HUC and CTL groups, p = 0.01. There was lower MPO positive cells in the HUC group than in the ADM group, p = 0.018. Posterior column astrocyte activation was increased in ADM and PSC lambs compared to HUC lambs, p = 0.03. Conclusion: The HUC as a skin patch for in utero spina bifida repair preserves spinal cord function by reducing underlying inflammation when compared to ADM.

Using Smartphones for Clinical Assessment in Cervical Spondylotic Myelopathy a Feasibility Study

Background Degenerative cervical myelopathy (DCM) is characterized by progressive deterioration in spinal cord function. Its evaluation requires subjective clinical examination with wide inter-observer variability. Objective quantification of spinal cord function remains imprecise, even though validated myelopathy-grading scales have emerged and are now widely used. We created a Smartphone App with the aim of quantifying accurately and reliably spinal cord dysfunction using a 5-minute Test. Methods A patient suffering from DCM was clinically evaluated before surgery, at 3 and 6 months follow-up after surgical decompression of the cervical spinal cord. Standard scores (Nurick grade, mJOA score) were documented at these time points. A 5-minute motor and proprioceptive performance test aided by a smartphone with the N-outcome app was also performed. Results Motor performance in rapid alternating movements and finger tapping improved in correlation with improvements in standard grading scale scores. Clinical improvements were seen in maximum reflex acceleration and in Romberg testing which showed less closed/open eyes variation, suggesting pyramidal and proprioceptive function recovery. Conclusions We demonstrate that using a smartphone app as an adjunct to clinical evaluation of compressive myelopathy is feasible and potentially useful. The results correlate with the results of clinical assessment obtained by standard validated myelopathy scores.

Nursing Intervention Study of Microscope-assisted Anterior and Posterior Fusion for Lower Cervical Spine Fracture and Dislocation

To explore the nursing intervention measures of microscopy-assisted anterior and posterior fusion in the treatment of lower cervical spine fracture and dislocation.46 patients with fracture and dislocation of lower cervical spine who were treated by microscope-assisted anterior and posterior fusion in our hospital from April 2018 to April 2019 were selected for this study, and divided into observation group and control group according to the different nursing interventions applied by the patients during the treatment. There were 23 patients in the two groups, while the patients in the control group were given routine nursing interventions. The patients in the observation group were given comprehensive nursing interventions. The curative effects of the treatment and nursing interventions in the two groups were observed, sorted out, analyzed and summarized. The changes of psychological status, recovery of spinal cord function, occurrence of complications and quality of life before and after nursing intervention were compared between the two groups.(l) Psychological status: Before nursing intervention, there was no significant difference in psychological status between the two groups, and there was no significant difference (P > 0.05); After nursing intervention, the SDS and SAS scores of patients in the observation group were better than those in the control group, and the difference was statistically significant (P < 0.05); (2) Recovery of spinal cord function: before nursing intervention, there was no significant difference in JOA scores of spinal cord function between the two groups, and the difference was not statistically significant (P > 0.05); After nursing intervention, JOA score of spinal cord function in the observation group was significantly better than that in the control group, the difference was statistically significant (P < 0.05); (3) Complication occurrence: Complication incidence in the observation group was lower than that in the control group, the difference was statistically significant (P < 0.05). (4) Quality of life: before nursing intervention, there was no significant difference in QOL scores between the two groups, and the difference was not statistically significant (P > 0.05); after nursing intervention, the QOL scores of patients in the observation group were better than those in the control group, and the difference was statistically significant (P < 0.05).Through the analysis, it was found that the operation of microscope-assisted anterior and posterior fusion therapy was more complicated and the risk of treatment was greater. The comprehensive nursing interventions throughout the preoperative, intraoperative and postoperative period played a vital role in improving the treatment effect of patients, which was not only conducive to the effective recovery of patients’ spinal cord function. At the same time, it can avoid complications in the treatment process, so as to promote the early recovery of the patient’s condition and improve the quality of life. In general, the application of comprehensive nursing interventions in the treatment of lower cervical spine fracture patients has higher application value, which is worthy of clinical vigorous promotion and.

Spinal cord synaptic plasticity by GlyRβ release from receptor fields and syndapin-dependent uptake

Glycine receptor-mediated inhibitory neurotransmission is key for spinal cord function. Recent observations suggested that by largely elusive mechanisms also glycinergic synapses display synaptic plasticity. We here identify syndapin I as critical player. Interestingly, syndapin I cooperates but in part also competes with gephyrin. Syndapin I deficiency led to fragmentation of glycine receptor fields, more disperse receptors and increased receptor mobility. Kainate treatment highlighted syndapin I's importance even more. Our analyses unveiled that PKC-mediated S403 phosphorylation-mediated glycine receptor β decoupling from gephyrin scaffolds simultaneously promoted syndapin I association. In line, kainate-treated syndapin I KO spinal cords showed even more severe receptor field fragmentation. Furthermore, syndapin I deficiency completely disrupted kainate-induced glycine receptor internalization. Together, this unveiled important mechanisms controlling the number and organization of glycine receptor fields at inhibitory postsynapses during both steady-state and kainate-induced synaptic rearrangement - principles organizing and fine-tuning synaptic efficacy of inhibitory synapses in the spinal cord.

Dermatomal Somatosensory Evoked Potentials And Cortical Somatosensory Evoked Potentials Assessment In Congenital Scoliosis

Background: The aim of this study was to assess the value of dermatomal somatosensory evoked potentials (DSEPs) and cortical somatosensory evoked potentials (SSEPs) in monitoring spinal cord function for patients with congenital scoliosis (CS). Methods: This study retrospectively analyzed the neurophysiological signals recorded in 62 patients from our orthopedic department who underwent MRI, CT and a specialist physical examination by a surgeon to confirm the diagnosis of CS. To observe the incidence of abnormal DSEPs and SSEPs in CS patients and to analyze the difference in sensitivity and reliability between the two in the examination of scoliosis patients. Results: All patients were evaluated with total spine magnetic resonance imaging (MRI). Only 23 patients (37.09%) showed intradural lesions in the MRI findings. Abnormal waveforms were observed in the DSEPs of 60 patients (96.8%) , 25 of which (40.3%) had abnormal waveforms in the tibial SSEPs, and the difference was statistically significant (P＜0.05). Of the 10 patients with clinical symptoms, 2 (20%) had abnormal tibial SSEPs waveforms , and 23 (44.2%) of 52 patients without clinical symptoms had abnormal tibial SSEPs waveforms. DSEPs are more sensitive to microscopic posterior column dysfunction in patients with CS that cannot be detected by either imaging or routine clinical examination. Conclusion: DSEPs provide evidence for the type of neurophysiological dysfunction in patients with congenital scoliosis. Preoperative DSEPs assessment is recommended as a baseline examination for intraoperative monitoring and comparison with the postoperative situation. DSEPs recording complements the information obtained from routine clinical and radiological evaluation.

Application of Magnetic Resonance Diffusion Tensor Imaging in the Clinical Diagnosis of Disc Herniation after Lumbar Spine Injury

Magnetic resonance diffusion-weighted imaging (DTI) provides a unique perspective on the pathophysiological and microstructural changes during spinal cord injury, with high spatial specificity; meanwhile, NM reflects the conduction and integrity of neuroelectrical signals in spinal cord fiber tracts, with time-specific and dynamic evaluation effects. The fractional anisotropy (FA) value, SEP amplitude, and neurological function score or improvement rate are correlated. The combination of DTI and NM can more reliably quantify the spinal cord function, evaluate the effectiveness of treatment, and determine the patient's prognosis, which can provide reference for clinical decision making and future research for SCI patients. That is, the lower the preoperative FA value and the lower the SEP amplitude, the worse the preoperative and postoperative neurological function, the lower the improvement rate, and the worse the prognosis of patients. Therefore, we believe that spinal cord function can be graded according to JOA scores to find the corresponding FA and SEP amplitude ranges and that, by measuring FA and SEP amplitude in the future, we can reverse the assessment of spinal cord function, expected postoperative improvement, and long-term prognosis. At the same time, FA values can also help determine the nature of the lesion to some extent.

IMPACT OF ACTIVE REHABILITATION ON WHEELCHAIR DISTANCE IN MEN WITH SPINAL CORD INJURY AT THE CERVICAL OR THORACIC LEVELS

The aim of the study was to evaluate the effect of Active Rehabilitation (AR) on wheelchair distance in men with spinal cord injury (SCI) at the cervical or thoracic levels. The research group consisted of 30 men with cervical or thoracic SCI. All the participants completed the "1st level" rehabilitation camp in Spała (12 days). A modified Cooper test was used twice: the day before and the day after the AR camp. AR had increased the distance covered in a wheelchair in men with thoracic (18%) and cervical (29%) SCI. The percentage of change in the Cooper test result due to AR has a statistically significant dependency on the degree of impairment of spinal cord function according to the ASIA scale (parametric test: p=0.0131, nonparametric test p=0.0018). The level of SCI does not significantly differentiate this variable (parametric test: p=0.3418, nonparametric test p=0.0673). Contrary to expectations, men with SCI at cervical level improved more, which suggests that AR is a valuable therapeutic component in the rehabilitation of patients with SCI. The wheelchair distance improvement due to AR depends more on the degree of impairment of the spinal cord function than on the level of the SCI itself.