Surgical treatment of metastatic spinal cord compression with or without neural deficit is controversial. Karnofsky and Tokuhashi scores have been proposed for prognosis of spinal metastasis. Here, we conducted a retrospective analysis of Karnofsky and modified Tokuhashi scores in 57 consecutive patients undergoing surgery for secondary spinal metastases to evaluate the value of these scores in aiding decision making for surgery. Comparison of preoperative Karnofsky and modified Tokuhashi scores with the type of the surgical approach for each patient revealed that both scores not only reliably estimate life expectancy, but also objectively improved surgical decisions. When the general status of the patient is poor (i.e., Karnofsky score less than 40% or modified Tokuhashi score of 5 or greater), palliative treatments and radiotherapy, rather than surgery, should be considered.

It is thus thought that combining citicoline with postconditioning provides protection by inhibiting the caspase pathway and by increasing the antiapoptotic proteins.

Objectives:The primary objective of this study was to analyze the clinical and radiologic outcomes of 3-level anterior cervical discectomy and fusion procedures performed using interbody cages without plate fixation.Methods: Twenty-two patients with radiculomyelopathy were retrospectively evaluated. Functional outcome of patients with radiculopathy was assessed using Odom's criteria, and myelopathic patients were rated according to Nurick's classification. Radiographs were used for evaluation of the cervical lordosis, fusion, foraminal height, and implant position.Results: An excellent or good functional result was found in all of the patients with radiculopathy. In addition, Nurick grades improved from a mean of 2.4 before surgery to a mean of 1.2 at follow-up (P = 0.007). These effects were accompanied by a significant increase in height of the foramina after surgery (P = 0.006). However, there was no statistically significant difference between cervical lordosis before surgery and at final follow-up. Fusion was observed in 17 (77.3%) of the patients, whereas the remaining 5 patients (22.7%) had asymptomatic pseudarthrosis. Of the 66 total cages implanted, subsidence was present in 31 (46.9%). The mean follow-up was 26.1 months.Conclusions: The use of interbody cages without plate fixation for 3-level anterior cervical discectomy increases cervical lordosis, increases foraminal height, assists fusion, and is associated with good clinical outcomes.

AIM:To investigate the anti-apoptotic and anti-oxidant effects of systemic uridine treatment in a rat model of sciatic nerve injury.MATERIAL and METHODS: Thirty-two adult male rats were equally randomized to Sham, Control, U100, and U500 groups. Sham rats received a sham operation by exposing the right sciatic nerve without transection, while those in the Control, U100, and U500 groups underwent right sciatic nerve transection followed by immediate primary anostomosis. Sham and Control groups received saline (0.9% NaCl) injections intraperitoneally (i.p.), while U100 and U500 groups received 100 mg/kg and 500 mg/kg uridine injections (i.p.), respectively, once a day for 7 days after the surgery. Rats in all the groups were sacrificed on the eighth day; sciatic nerve samples were analyzed for apoptosis by Western Blotting and for oxidation parameters including myeloperoxidase (MPO), malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GPx) and catalase (CAT) by Enzyme-Linked Immunosorbent Assay (ELISA). RESULTS:Uridine treatment at the dose of 500 mg/kg significantly decreased as apoptosis determined by Caspase-3/Actin ratio and exhibited significant anti-oxidant effects as determined by decreased levels of MPO and MDA as well as increased levels of SOD, GPx, and CAT compared to controls. Uridine at 100 mg/kg was only found to decrease the Caspase-3/Actin ratio, although it significantly decreased MDA and increased CAT levels compared to controls. CONCLUSION:Treatment with uridine reduces apoptosis and oxidation in a rat model of sciatic nerve injury dose-dependently. Thus, uridine may be beneficial in peripheral nerve regeneration by exhibiting anti-apoptotic and anti-oxidant effects.

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