Search Results (323)

Background: Anterior cervical discectomy and fusion (ACDF) is a common treatment for cervical radiculopathy and myelopathy. While generally effective, diabetes mellitus may increase postoperative complications and healthcare costs. This study evaluated the impact of type 2 diabetes on perioperative outcomes in ACDF patients. Methods: A retrospective cohort study was conducted using the Nationwide Inpatient Sample (2016–2019), including 85,585 single-level ACDF patients. Propensity score matching (PSM) was applied, creating two balanced cohorts (16,260 diabetic and 16,260 non-diabetic patients). Outcomes analyzed included postoperative complications, length of stay, hospital charges, and mortality. Results: Diabetic patients had significantly higher risks of ACDF-specific complications, including cerebrospinal fluid leaks (2×), dysphagia (2.5×), dysphonia (2.9×), and cervical spinal cord injury (5×). General complications were also increased, with higher rates of pulmonary embolism (2.4×), sepsis (3×), stroke (3×), pneumonia (3.3×), and heart failure (12×). Diabetic patients had longer hospital stays (1.99 vs. 1.79 days, p < 0.001) and higher hospital charges (USD 71,884 vs. USD 67,998, p = 0.004). Conclusions: T2DM significantly increases postoperative risks, length of stay, and costs for ACDF patients. Optimized perioperative management and glucose control are essential to improve outcomes in this high-risk population. Full article

Mesenchymal progenitor cells (MPC) are effective in reducing tissue loss, preserving white matter, and improving forelimb function after a spinal cord injury (SCI). We proposed that by preconditioning the mouse by the intravenous delivery (IV) of MPCs for 24 h following SCI, this would provide a more favorable tissue milieu for an NSC intraspinal bridging transplantation at day three and day seven. In combination, these transplants will provide better anatomical and functional outcomes. The intravenous MSCs would provide cell protection and reduce inflammation. NSCs would provide a tissue bridge for axonal regeneration and myelination and reconnect long tract spinal pathways. Results showed that initial protection of the injury site by IV MPCs transplantation resulted in no increased survival of the NSCs transplanted at day seven. However, integration of transplanted NSCs was increased at the day three timepoint, indicating MPCs influence very early immune signaling. We show, in this study, that MPC transplantation resulted in a co-operative NSC cell survival improvement on day three post-SCI. In addition to increased NSC survival on day three, there was an increase in NSC-derived mature oligodendrocytes at this early timepoint. An in vitro analysis confirmed MPC-driven oligodendrocyte differentiation, which was statistically increased when compared to control NSC-only cultures. These observations provide important information about the combination, delivery, and timing of two cellular therapies in treating SCI. This study provides important new data on understanding the MPC inflammatory signaling within the host tissue and timepoints for cellular transplantation survival and oligodendroglia differentiation. These results demonstrate that MPC transplantation can alter the therapeutic window for intraspinal transplantation by controlling both the circulating inflammatory response and local tissue milieu. Full article

Background/Objectives: The hypoglossal nerve plays a crucial role in cervical surgery, requiring precise anatomical knowledge to prevent iatrogenic injury. This study examined its position relative to key structures using cadaveric dissections and assessed ChatGPT-4’s reliability in providing anatomical insights. Methods: Ten cadavers were dissected to identify the hypoglossal nerve’s course in relation to the internal jugular vein, carotid arteries, thyro-linguo-facial trunk, hyoid bone, and digastric muscle. Measurements were taken, and ChatGPT was queried for anatomical guidance and surgical recommendations. Results: The hypoglossal nerve was consistently medial to the internal jugular vein and lateral to the carotid arteries. The measured distances to the surrounding structures showed notable variability, particularly with the thyro-linguo-facial trunk. ChatGPT accurately described major landmarks but overlooked lesser-known anatomical triangles and provided no additional dissection guidance. It primarily suggested intraoperative monitoring and preoperative imaging. Conclusions: The carotid and submandibular triangles serve as reliable landmarks for identifying the hypoglossal nerve. This study highlights an unreported variability in its relationship with the thyro-linguo-facial trunk. ChatGPT, while informative, lacked detailed surgical applicability for dissection. Full article

Minimal facet and lateral mass fractures of the subaxial cervical spine (C3–C7) are a distinct subset of spinal injuries that present diagnostic and therapeutic challenges. These fractures often result from low-energy trauma or hyperextension mechanisms. They are frequently stable. However, subtle fracture instability and associated soft tissue injuries may lead to delayed instability, neurological compromise, and/or chronic severe pain if not properly identified. Accurate diagnosis relies on a combination of plain radiography, high-resolution computed tomography (CT), and magnetic resonance imaging (MRI) to assess bony and ligamentous integrity. Treatment strategy is determined based on fracture stability, neurological status, and radiographic findings. Most stable fractures can be effectively treated with conservative treatment, allowing for natural healing while minimizing complications. However, when instability is suspected—such as those with significant disc and ligamentous injuries, progressive deformity, or neurological deficits—surgical stabilization may be considered. The presence of vertebral artery injury (VAI) can further complicate management. To mitigate the risk of stroke, a multidisciplinary approach that includes neurosurgery, vascular surgery, and interventional radiology is needed. Surgical treatment aims to restore spinal alignment, maintain stability, and prevent further neurological deterioration with approaches tailored to individual fracture patterns and patient-specific factors. Advances in surgical techniques, perioperative management, and endovascular interventions for VAI continue refining treatment options to improve clinical outcomes while minimizing complications. Despite increasing knowledge of these fractures and associated vascular injuries, optimal treatment strategies remain unclear due to limited high-quality evidence. This review provides a comprehensive analysis of the anatomy, biomechanics, classification, imaging modalities, and treatment strategies for minimal facet and lateral mass fractures in the subaxial cervical spine, highlighting recent advancements in diagnostic tools, therapeutic approaches, and managing vertebral artery injuries. A more precise understanding of the natural history and optimal management of these injuries will help spine specialists refine clinical decision-making and improve patient outcomes. Full article

Background/Objectives: This study evaluated the effects of a tactile-discrimination compensatory real-time feedback device on hand sensorimotor function in cervical spinal cord injury patients. The study assessed changes in hand numbness, dexterity, and electroencephalogram (EEG) activity, particularly γ-wave power in the sensorimotor area during skilled finger movements. Methods: Three patients with cervical spinal cord injury who presented with hand sensorimotor dysfunction underwent treatment with this device. All cases underwent the intervention using an AB design; A is the exercise task without the system device, and B is the exercise task under the system device. To confirm the reproducibility and minimize the influence of confounding factors, a multiple-baseline design, in which the intervention period was staggered for each subject, was applied. To determine efficacy, the hand numbness numerical rating scale, peg test, and EEG were measured daily, and Tau-U calculations were performed. Results: In two of three cases, moderate or very large changes were observed in numbness in B. In all cases, there was a large or very large change in the peg test results in the B. Regarding EEG activity, the non-skilled participants showed amplification of γ-wave power in the sensorimotor area during the B. Conversely, in the skilled participants, the γ-wave power of the sensorimotor area was attenuated during skillful movements. Conclusions: These findings indicate that the ability of the brain to compare and align predictive control with sensory feedback might be compromised in patients with damage to the afferent pathways of the central nervous system. Moreover, the use of this device appears to have played a role in supporting functional recovery. Full article

Background and Objective: Probiotics have been shown to be effective in controlling various adverse health conditions such as antibiotic-associated diarrhea, inflammatory bowel disease, obesity, and neurological diseases. However, to our knowledge, there is no research on the preventive effect of probiotics on heart damage caused by infections. This study examined the preventive benefits of probiotics against sepsis-related heart injury using a rat model caused by lipopolysaccharide (LPS). Materials and Methods: Four groups of twenty-four male Wistar albino rats, each with six rats, were set up. For 14 days, Group 1 (Sham Group) was given oral normal saline, intraperitoneal Escherichia coli O111-B4 lipopolysaccharide (LPS Group) was given to Group 2, and oral probiotics were given to Group 3 (Probiotic Group). Escherichia coli O111-B4 lipopolysaccharide was injected intraperitoneally after Group 4 (Probiotic + LPS) received oral probiotics containing Lactobacillus rhamnosus GG and Bifidobacterium animalis subsp. lactis BB-12 (10⁹ CFU/day). Blood samples were taken twenty-four hours following the administration of LPS. The animals were then euthanized by cervical dislocation, and samples of cardiac tissue were taken in order to assess any damage to the heart. The following serum values were measured: C-reactive protein (CRP), creatine kinase-myocardial band (CK-MB), cardiac troponin subunit I (cTn-I), tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), and interleukin-6 (IL-6). The TNF-α, IL-1β, IL-6, glutathione (GSH), malondialdehyde (MDA), Total Oxidant Status (TOS), Total Antioxidant Status (TAS), Oxidative Stress Index (OSI), CRP, CK-MB, and cTn-I levels were assessed in tissue samples. Additionally, staining techniques were used to analyze histopathological alterations in tissues. Results: With the exception of serum IL-6 (p = 0.111), tissue and serum cytokine levels were considerably greater in the sepsis group (Group 2) than in the other groups (p < 0.05 to <0.001). The TAS, GSH, and SOD levels were significantly lower (p < 0.05 to <0.001) in septic rats, although the tissue levels of TOS, OSI, and MDA were significantly higher. With the exception of serum CRP in Group 3 (p = 0.328), the CK-MB, CRP, and cTn-I levels were considerably higher in Group 2 than in the other groups (p < 0.01 to <0.001). When compared to the other groups, histopathological examination showed significant alterations in the LPS group. Conclusions: Probiotics showed positive effects on oxidative stress markers and dramatically decreased sepsis-induced cardiac damage in the LPS-induced sepsis model. These results imply that probiotics could be used as a therapeutic approach to lessen the cardiac damage brought on by sepsis. Full article

Background: The rapid expansion of the brain–computer interface for patients with neurological deficits has garnered significant interest, and for patients, it provides an additional route where conventional rehabilitation has its limits. This has particularly been the case for patients who lose the ability to communicate. Circumventing neural injuries by recording from the intact cortex and subcortex has the potential to allow patients to communicate and restore self-expression. Discoveries over the last 10–15 years have been possible through advancements in technology, neuroscience, and computing. By examining studies involving intracranial brain–computer interfaces that aim to restore communication, we aimed to explore the advances made and explore where the technology is heading. Methods: For this scoping review, we systematically searched PubMed and OVID Embase. After processing the articles, the search yielded 41 articles that we included in this review. Results: The articles predominantly assessed patients who had either suffered from amyotrophic lateral sclerosis, cervical cord injury, or brainstem stroke, resulting in tetraplegia and, in some cases, difficulty speaking. Of the intracranial implants, ten had ALS, six had brainstem stroke, and thirteen had a spinal cord injury. Stereoelectroencephalography was also used, but the results, whilst promising, are still in their infancy. Studies involving patients who were moving cursors on a screen could improve the speed of movement by optimising the interface and utilising better decoding methods. In recent years, intracortical devices have been successfully used for accurate speech-to-text and speech-to-audio decoding in patients who are unable to speak. Conclusions: Here, we summarise the progress made by BCIs used for communication. Speech decoding directly from the cortex can provide a novel therapeutic method to restore full, embodied communication to patients suffering from tetraplegia who otherwise cannot communicate. Full article

Whiplash injuries (WLs) are the most frequent cause of emergency room visits after motor vehicle collisions. In clinical practice, massage, electrotherapy, mobilization, or therapeutic exercise are used. As part of manual therapy, high-velocity, low-amplitude manipulative techniques can also be used. Objectives: To evaluate the effect of the cervical Specific Adjustment Technique (SAT) in adults affected by whiplash on pain, functionality, cervical mobility, and radiological changes in cervical curvature through a prospective, single-blind, randomized clinical trial. Methods: One hundred and nineteen patients with grade II acute WL were randomly assigned to either the manipulation group (MAN group = 59) or the rehabilitation group (RHB group = 60) to receive 3 or 20 sessions of treatment, respectively. Both groups were measured at baseline and 15, 30, and 120 days after starting treatment. Results: Statistically significant differences were found in the MAN group in flexion (p = 0.041) and left-side bending (p = 0.022); similar statistical values were found in the other measures. According to the interaction treatment-time effect, statistical significance for the Cobb angle was obtained in the MAN group (p = 0.047). Conclusions: the effects of SAT were comparable in terms of pain, functionality, and mobility of the cervical spine. Although further research is needed on its effects in the acute phase, due to its effectiveness and lower associated cost, SAT could be considered a useful technique, at least during the first 3 months after a traffic collision. Full article

A stinger is the transient sensory and motor loss of one upper extremity caused by a stretch or compression injury to the brachial plexus or the exiting cervical nerve roots. Athletes from contact sports like American football, rugby, wrestling, and horseback riding are most affected. Given today’s competitive athletic culture and recent advancements in sports medicine, understanding the clinical, diagnostic, and therapeutic aspects of stingers is crucial. Thus, this narrative review highlights current knowledge of pathology, clinical features, diagnostic modalities, radiologic measurements, management, rehabilitation, and return-to-play protocols. Recent and prominent English publications on adult athletes revealed that the brachial plexus upper roots (C5 and C6) are most affected. Stingers accounted for 62.2% of neck injuries in National Football League athletes and affected up to 50.3% of football players. Grading is based on injury severity to the nerves. Most stingers are mild, lasting a few seconds to minutes. Return-to-play protocols remain controversial; however, stingers have promising prognoses and can mostly be resolved with conservative treatment and rehabilitation. Severe injuries require surgical intervention but rarely occur in athletics. In conclusion, many recent developments in the evaluation and treatment of stingers impact current treatment plans, return-to-play decisions, and the future of athletes. Full article

Vertebral fracture (VF) may induce spinal cord injury that can lead to serious consequences which eventually may paralyze the entire or some parts of the body depending on the location and severity of the injury. Diagnosis of VFs is crucial at the initial stage, which may be challenging because of the subtle features, noise, and homogeneity present in the computed tomography (CT) images. In this study, Wide ResNet-40, DenseNet-121, and EfficientNet-B7 are chosen, fine-tuned, and used as base models, and a Bayesian-based probabilistic ensemble learning method is proposed for fracture detection in cervical spine CT images. The proposed method considers the prediction’s uncertainty of the base models and combines the predictions obtained from them, to improve the overall performance significantly. This method assigns weights to the base learners, based on their performance and confidence about the prediction. To increase the robustness of the proposed model, custom data augmentation techniques are performed in the preprocessing step. This work utilizes 15,123 CT images from the RSNA-2022 C-spine fracture detection challenge and demonstrates superior performance compared to the individual base learners, and the other existing conventional ensemble methods. The proposed model also outperforms the best state-of-the-art (SOTA) model by 1.62%, 0.51%, and 1.29% in terms of accuracy, specificity, and sensitivity, respectively; furthermore, the AUC score of the best SOTA model is lagging by 5%. The overall accuracy, specificity, sensitivity, and F1-score of the proposed model are 94.62%, 93.51%, 95.29%, and 93.16%, respectively. Full article

Background/Objectives: Spinal cord injury (SCI) causes profound autonomic and endocrine dysfunctions, giving rise to adrenal insufficiency (AI), which is marked by a reduction in steroid hormone production. Left unaddressed, SCI-related AI (SCI-AI) can lead to life-threatening consequences such as severe hypotension and shock (i.e., adrenal crisis). However, symptoms are often non-specific, making AI challenging to distinguish from similar or overlapping cardiovascular conditions (e.g., orthostatic hypotension). Additionally, the etiology of SCI-AI remains unknown. This review aimed to synthesize the current literature reporting the prevalence, symptomology, and management of SCI-AI. Methods: A systematic search was performed to identify studies reporting AI following the cessation of glucocorticoid treatments in individuals with traumatic SCI. A random-effects meta-analysis was conducted to investigate the overall prevalence of SCI-AI. Results: Thirteen studies involving 545 individuals with traumatic SCI, most with cervical level injuries (n = 256), met the review criteria. A total of 4 studies were included in the meta-analysis. Primary analysis results indicated an SCI-AI pooled prevalence of 24.3% (event rate [ER] = 0.243, 95% confidence interval [CI] = 0.073–0.565, n = 4). Additional sensitivity analyses showed a pooled prevalence of 46.3% (ER = 0.463, 95%CI = 0.348–0.582, n = 2) and 10.8% (ER = 0.108, 95%CI = 0.025–0.368, n = 2) for case–control and retrospective cohort studies, respectively. High-dose glucocorticoid administration after SCI as well as the injury itself appear to contribute to the development of AI. Conclusions: The estimated prevalence of AI in people with traumatic SCI was high (24%). Prevalence was also greater among individuals with cervical SCI than those with lower-level lesions. Clinicians should be vigilant in recognizing the symptomatology and onset of SCI-AI. Further research elucidating its underlying pathophysiology is needed to optimize glucocorticoid administration for remediating AI in this vulnerable population. Full article

Background: The dorsal scapular nerve (DSN) and the long thoracic nerve (LTN) exhibit variable anatomical pathways, which may contribute to upper back pain and impaired scapular movement in affected patients. This study investigates these variations to enhance clinicians’ diagnostic and surgical approaches. Methods: The bilateral cervical regions of 32 formalin-embalmed donors (64 sides) were dissected to document the origin of the DSN, the relationship with the scalene muscles of the DSN, and anatomical connections between the DSN and LTN. Measurements of the distance between the mastoid process and the piercing point of the DSN to the scalene muscle were obtained with digital calipers. Additional measurements were obtained from the medial border of the scapula at two specific locations: the scapular spine (zone 1) and the midpoint between the scapular spine and the inferior angle of the scapula (zone 2). Results: The DSN demonstrated four distinct cervical spinal nerve root origins and five unique scalene muscle piercing patterns. The average distance between the DSNs’ scalene muscle piercing point and the mastoid process was 94.87 ± 10.09 mm, with significantly greater distances observed in male donors compared to female donors (p < 0.001). Connections between the DSN and LTN were identified in 65.2% of the examined cervical regions. The mean distance of the DSN from the medial border of the scapula at zone 2 was significantly greater than at zone 1 (p < 0.001). Conclusions: The anatomical variation findings and classification of the DSN provide valuable insights, offering guidance for conducting clinical procedures of the scalene and rhomboid musculature in a way that minimizes the risk of iatrogenic injury. The documented variations may also assist in the diagnosis and management of DSN-related pathologies such as DSN neuropathy. Full article

Background/Objectives: Responsiveness and minimal important change (MIC) are key metrics that vary across conditions and should be determined for specific populations. However, these metrics have not yet been established for the Mini-Balance Evaluation Systems Test (Mini-BESTest) and Brief-BESTest in people with subacute traumatic incomplete cervical spinal cord injury (iCSCI). In this study, we aimed to determine the responsiveness and MIC of the Mini-BESTest and Brief-BESTest in people with subacute iCSCI. Methods: This study included people with iCSCI who could maintain the standing position for 30 s without assistance within 7 days of injury at the university hospital’s advanced critical care center. Responsiveness was assessed by correlating Mini-BESTest and Brief-BESTest change scores with the Berg Balance Scale (BBS). MIC values were determined using the global rating of change scale as an anchor, employing receiver operating characteristic curve methods (MIC_ROC) and predictive modeling methods adjusted for the proportion of improved participants (MIC_adjusted). Results: Fifty people with iCSCI were included in the analysis. Changes in BBS scores were moderately positively correlated with changes in Mini-BESTest and Brief-BESTest scores. MIC_adjusted values were 3.7 for the Mini-BESTest and 2.2 for the Brief-BESTest. The MIC_ROC, based on an improvement rate of 64%, was deemed less appropriate for interpreting meaningful changes due to the high proportion of improved participants. Conclusions: MIC_adjusted benchmarks can help clinicians measure significant improvements in dynamic balance, design effective interventions, and evaluate rehabilitation outcomes in people with iCSCI. Full article

Corpectomy is the surgical procedure of resecting a vertebral body or a part of it in order to decompress neural structures. Corpectomy is performed in patients with degenerative disease or cancer and following injury to the spine. We present a case of multilevel corpectomy in a female patient with massive degenerative disease associated with rheumatoid arthritis, combined with cervical myelopathy and osteoporosis. We present the case of a female patient who underwent C4-C5-C6 corpectomy and spinal stabilisation with a Cervical 3D Expandable cage and a cervical plate attached to the C3-C7 bodies. The rheumatoid arthritis caused degenerative changes, which, combined with the impact of environmental conditions and the patient’s postural defects, led to a pathological profile of the spine along the vertical and transverse axis, manifesting clinically as a cervical myelopathy with its characteristic neurological symptoms. Pre-operative imaging studies revealed a critical stenosis of the spinal canal. This report showcases an effective surgical technique for severe degenerative disease bearing an increased risk of tetraplegia that could be brought on by even a minor injury to the cervical spine in the presence of this kind of pathology. Multilevel cervical corpectomy can be an effective method for treating spinal canal stenosis to prevent the onset of neurological deficits. This procedure requires careful diagnostic work-up, surgical planning and an interdisciplinary approach, especially in patients with co-morbidities. Full article

This study used the Anybody musculoskeletal model to investigate the effects of different neutral postures on the cervical spine and its associated muscle mechanical properties in various gravitational environments. A full-body musculoskeletal model (male, height: 1.74 m, mass: 74 kg) from the AMMR database, developed using the Anybody Modeling System, was employed to perform a quantitative analysis of three postures, including the neutral body posture in microgravity (NBP 0G), the neutral body posture in normal gravity (NBP 1G), and the relaxed standing posture in microgravity (SM 0G). The results showed that, compared to the NBP 1G posture in a gravitational environment, adopting the NBP 0G posture in microgravity resulted in an average reduction of 76.6% in the compressive force of the intervertebral discs, with shear forces in the same direction decreasing by 7.97 to 12.57 N. The shear force direction at the C6–C7 and C7–T1 segments changed, the intervertebral disc height increased by 1.6–4.8%, the disc cross-sectional area expanded by 3.2–6.9%, and the disc volume expanded by 4.8–9.4%. In addition, the total muscle force at the cervical region decreased while the ligament force increased. These changes in mechanical properties may significantly increase the risk of cervical disc herniation and degenerative disc diseases, as well as the risk of muscle atrophy in the neck. Full article