Clinical outcomes of late decompression surgery following cervical spinal cord injury with pre-existing cord compression

Konomi, Tsunehiko; Yasuda, Akimasa; Fujiyoshi, Kanehiro; Yamane, Junichi; Kaneko, Shinjiro; Komiyama, Takatsugu; Takemitsu, Masakazu; Yato, Yoshiyuki; Tsuji, Osahiko; Matsumoto, Morio; Nakamura, Masaya; Asazuma, Takashi

doi:10.1038/s41393-017-0019-1

Cited by 6 publications

(6 citation statements)

References 39 publications

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“…On the other hand, a study conducted by Yang et al 162 has produced conductive PPy/Alg hydrogel at various concentrations of Py monomers (PPy[0]/Alg, PPy [2]/Alg, PPy [5]/ Alg, and PPy[10]/Alg). The resultant hydrogels showed a nonuniform pore shape but interconnecting microporous structure.…”

Section: Physical Modulation 411 Stiffness (Elastic Modulus)mentioning

confidence: 99%

“…3,4 Current clinical therapies such as surgical decompression and rehabilitation are limited to reducing the propagation of cell and tissue damage, yet they do not promote repair or regeneration. 5 Furthermore, although post-injury rehabilitation has recently been proven to be essential in motor function recovery attributed to the neuroplasticity of the central nervous system (CNS), the majority of the rehabilitated SCI patients were reportedly still unable to walk without assistance and experiencing major pains. 6−8 Recent clinical attempts to repair SCI, including a neuroprotection approach to promote the protection of injured tissue and stimulate endogenous reaction for tissue regeneration, have not shown completely satisfactory outcomes either.…”

Section: Introductionmentioning

confidence: 99%

“…This event compromises the blood–spinal cord barrier (BSCB) allowing inflammatory cytokines to infiltrate, causing the demyelination of axons and the dissolution of neuronal cell bodies. This results in the formation of a cystic cavity and glial scarring which inhibits the regeneration of the axon. , Current clinical therapies such as surgical decompression and rehabilitation are limited to reducing the propagation of cell and tissue damage, yet they do not promote repair or regeneration . Furthermore, although post-injury rehabilitation has recently been proven to be essential in motor function recovery attributed to the neuroplasticity of the central nervous system (CNS), the majority of the rehabilitated SCI patients were reportedly still unable to walk without assistance and experiencing major pains. − Recent clinical attempts to repair SCI, including a neuroprotection approach to promote the protection of injured tissue and stimulate endogenous reaction for tissue regeneration, have not shown completely satisfactory outcomes either. − Meanwhile, the disruption of electrical signals in the spinal cord after the injury makes the reconstruction of spinal circuitries and neural conduction rather challenging.…”

Section: Introductionmentioning

confidence: 99%

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Application of Conductive Hydrogels on Spinal Cord Injury Repair: A Review

Shahemi

Mahat

Asri

et al. 2023

ACS Biomater. Sci. Eng.

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Spinal cord injury (SCI) causes severe motor or sensory damage that leads to long-term disabilities due to disruption of electrical conduction in neuronal pathways. Despite current clinical therapies being used to limit the propagation of cell or tissue damage, the need for neuroregenerative therapies remains. Conductive hydrogels have been considered a promising neuroregenerative therapy due to their ability to provide a pro-regenerative microenvironment and flexible structure, which conforms to a complex SCI lesion. Furthermore, their conductivity can be utilized for noninvasive electrical signaling in dictating neuronal cell behavior. However, the ability of hydrogels to guide directional axon growth to reach the distal end for complete nerve reconnection remains a critical challenge. In this Review, we highlight recent advances in conductive hydrogels, including the incorporation of conductive materials, fabrication techniques, and cross-linking interactions. We also discuss important characteristics for designing conductive hydrogels for directional growth and regenerative therapy. We propose insights into electrical conductivity properties in a hydrogel that could be implemented as guidance for directional cell growth for SCI applications. Specifically, we highlight the practical implications of recent findings in the field, including the potential for conductive hydrogels to be used in clinical applications. We conclude that conductive hydrogels are a promising neuroregenerative therapy for SCI and that further research is needed to optimize their design and application.

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Section: Physical Modulation 411 Stiffness (Elastic Modulus)mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Application of Conductive Hydrogels on Spinal Cord Injury Repair: A Review

Shahemi

Mahat

Asri

et al. 2023

ACS Biomater. Sci. Eng.

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“…A further 70 articles were excluded due to different study design or insufficient data available. Ultimately, 10 papers met the selection criteria and were included in this metaanalysis (18)(19)(20)(21)(22)(23)(24)(25)(26)(27). The search process and full inclusion/ exclusion criteria are shown in Figure 1.…”

Section: Literature Selectionmentioning

confidence: 99%

A systematic review and meta-analysis compare surgical treatment and conservative treatment in patients with cervical spondylotic myelopathy

et al. 2021

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Background: Cervical spondylotic myelopathy (CSM) can be managed by conservative treatment or surgical treatment. This study aimed to compare the clinical effects of conservative treatment versus surgical treatment for patients with CSM.Methods: Reports of randomized controlled trials and retrospective cohort studies that compared surgical treatment versus conservative treatment for CSM were collated from medical databases. The following data were extracted from eligible studies: pre-and post-treatment Japanese Orthopedic Association (JOA) scores, recovery rate, American Spinal Injury Association (ASIA) scores, and ASIA grade change. Results were expressed as risk ratio (RR) and mean difference (MD) with 95% confidence intervals (CIs).Results: A total of 10 studies were included in this meta-analysis, with a total of 517 patients. Patients who received surgical treatment had lower pre-treatment JOA scores compared to patients who received conservative treatment (P=0.01). However, there was no difference in the post-treatment JOA scores between the two types of treatment (P=0.70). This demonstrated that the increase in JOA score was greater in the surgical group compared to the conservative group. Additionally, patients in the surgical group had a higher recovery rate than patients in the conservative group (P<0.00001). Although this investigation showed no significant difference in ASIA score between the two groups (P=0.30), there was a definite difference in ASIA grade change after sensitivity analysis.Discussion: This meta-analysis suggested that surgical treatment may be more advantageous than conservative treatment in patients with CSM. However, these findings should be verified with larger, multicentered, follow-up, controlled trials.

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“…Another group was treated conservatively and did not fare worse. Konomi et al 42 stressed that surgical efficacy was not proven without preexisting cord compression by at least 40%.…”

Section: Literature Reviewmentioning

confidence: 99%

Pros and Cons of Early and Very Early Surgery for Traumatic Central Cord Syndrome with Spinal Stenosis: Literature Review and Case Report

Hildebrandt

Joswig

Stienen

et al. 2021

J Neurol Surg A Cent Eur Neurosurg

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Background The case of a 69-year-old patient with an acute traumatic central cord syndrome (ATCCS) with preexisting spinal stenosis raised a discussion over the question of conservative versus surgical treatment in the acute setting. We provide a literature overview on the management (conservative vs. surgical treatment) of ATCCS with preexisting spinal stenosis. Methods We reviewed the literature concerning essential concepts for the management of ATCCS with spinal stenosis and cervical spinal cord injury. The data retrieved from these studies were applied to the potential management of an illustrative case report. Results Not rarely has ATCCS an unpredictable neurologic course because of its dynamic character with secondary injury mechanisms within the cervical spinal cord in the early phase, the possibility of functional deterioration, and the appearance of a neuropathic pain syndrome during late follow-up. The result of the literature review favors early surgical treatment in ATCCS patients with preexisting cervical stenosis. Conclusion Reluctance toward aggressive and timely surgical treatment of ATCCS should at least be questioned in patients with preexisting spinal stenosis.

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Clinical outcomes of late decompression surgery following cervical spinal cord injury with pre-existing cord compression

Abstract: These results indicate that surgical treatment has an advantage for patients following traumatic CSCI with severe cord compression. In contrast, surgical efficacy is not proved for CSCI patients without severe cord compression.

Cited by 6 publications

References 39 publications

Application of Conductive Hydrogels on Spinal Cord Injury Repair: A Review

Application of Conductive Hydrogels on Spinal Cord Injury Repair: A Review

A systematic review and meta-analysis compare surgical treatment and conservative treatment in patients with cervical spondylotic myelopathy

Pros and Cons of Early and Very Early Surgery for Traumatic Central Cord Syndrome with Spinal Stenosis: Literature Review and Case Report

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