Spinal cord pathology revealed by MRI in traumatic spinal cord injury

Pfyffer, Dario; Freund, Patrick

doi:10.1097/wco.0000000000000998

Cited by 5 publications

(7 citation statements)

References 47 publications

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“…However, because of the poor sensitivity associated with plain radiography, more often it is replaced by CT without contrast, which can better characterize vertebral fractures but has very poor sensitivity for soft tissue injuries 14 . For unconscious patients and those in whom no obvious traumatic spinal fracture has occurred, conventional MRI, specifically sagittal T1-weighted and sagittal and axial T2-weighted imaging, is helpful to assess the degree of traumatic spinal cord compression and extramedullary abnormalities (edema and hemorrhage) ( case 2-1 ) 24 . MRI is also useful in evaluating the extent of spinal cord compression and disk herniation and excellent in detecting compressive epidural and intramedullary hematomas, which can be crucial in guiding surgical decisions.…”

Section: Discussionmentioning

confidence: 99%

“…MRI is also useful in evaluating the extent of spinal cord compression and disk herniation and excellent in detecting compressive epidural and intramedullary hematomas, which can be crucial in guiding surgical decisions. MRI findings, such as the extent and location of spinal cord injury, can help clinicians predict functional outcomes and develop rehabilitation strategies 24,25 …”

Section: Discussionmentioning

confidence: 99%

“…MRI findings, such as the extent and location of spinal cord injury, can help clinicians predict functional outcomes and develop rehabilitation strategies. 24,25 Additionally, MRI, including short tau inversion recovery (STIR) sequences, within 48 hours of the trauma can help assess for the amount of occult ligamentous instability at the level of the injury, which has been associated with increased risk for subluxation. In the subacute and chronic phases after a traumatic spinal injury, MRI can also be helpful in evaluating for a syrinx and progressive ascending myelomalacia.…”

Section: Key Pointsmentioning

confidence: 99%

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Traumatic Spinal Cord Injury

Izzy

2024

CONTINUUM: Lifelong Learning in Neurology

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OBJECTIVE This article provides a review of the initial clinical and radiologic evaluation and treatment of patients with traumatic spinal cord injuries. It specifically highlights essential knowledge for neurologists who encounter patients with these complex injuries. LATEST DEVELOPMENTS There has been improvement in the care of patients with traumatic spinal cord injuries, particularly in the prehospital evaluation, approach for immediate immobilization, standardized spinal clearance, efficient triage, and transportation of appropriate patients to traumatic spinal cord injury specialized centers. Advancements in spinal instrumentation have improved the surgical management of spinal fractures and the ability to manage patients with spinal mechanical instability. The clinical evidence favors performing early surgical decompression and spine stabilization within 24 hours of traumatic spinal cord injuries, regardless of the severity or location of the injury. There is no evidence that supports the use of neuroprotective treatments to improve outcomes in patients with traumatic spinal cord injuries. The administration of high-dose methylprednisolone, which is associated with significant systemic adverse effects, is strongly discouraged. Early and delayed mortality rates continue to be high in patients with traumatic spinal cord injuries, and survivors often confront substantial long-term physical and functional impairments. Whereas the exploration of neuroregenerative approaches, such as stem cell transplantation, is underway, these methods remain largely investigational. Further research is still necessary to advance the functional recovery of patients with traumatic spinal cord injuries. ESSENTIAL POINTS Traumatic spinal cord injury is a complex and devastating condition that leads to long-term neurologic deficits with profound physical, social, and vocational implications, resulting in a diminished quality of life, particularly for severely affected patients. The initial management of traumatic spinal cord injuries demands comprehensive interdisciplinary care to address the potentially catastrophic multisystem effects. Ongoing endeavors are focused on optimizing and customizing initial management approaches and developing effective therapies for neuroprotection and neuroregeneration to enhance long-term functional recovery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Key Pointsmentioning

confidence: 99%

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Traumatic Spinal Cord Injury

Izzy

2024

CONTINUUM: Lifelong Learning in Neurology

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“…Chronic injury lasts for several months or years and is characterized by cystic cavity formation, glial scar formation, and axonal dieback. [ 39 ] The pathophysiology of secondary SCI is shown in Figure .…”

Section: Pathophysiology Of Spinal Cord Injurymentioning

confidence: 99%

Hydrogel and Nanomedicine‐Based Multimodal Therapeutic Strategies for Spinal Cord Injury

Yin,

Liang,

Han

et al. 2023

Small Methods

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Spinal cord injury (SCI) is a severe neurodegenerative disease caused by mechanical and biological factors, manifesting as a loss of motor and sensory functions. Inhibition of injury expansion and even reversal of injury in the acute damage stage of SCI are important strategies for treating this disease. Hydrogels and nanoparticle (NP)‐based drugs are the most effective, widely studied, and clinically valuable therapeutic strategies in the field of repair and regeneration. Hydrogels are 3D flow structures that fill the pathological gaps in SCI and provide a microenvironment similar to that of the spinal cord extracellular matrix for nerve cell regeneration. NP‐based drugs can easily penetrate the blood‐spinal cord barrier, target SCI lesions, and are noninvasive. Hydrogels and NPs as drug carriers can be loaded with various drugs and biological therapeutic factors for slow release in SCI lesions. They help drugs function more efficiently by exerting anti‐inflammatory, antioxidant, and nerve regeneration effects to promote the recovery of neurological function. In this review, the use of hydrogels and NPs as drug carriers and the role of both in the repair of SCI are discussed to provide a multimodal strategic reference for nerve repair and regeneration after SCI.

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“… 7 However, the extent of sensory, motor, and autonomic function recovery after an SCI correlates with the post-injury operative time. 8 Currently, there is no effective treatment for traumatic SCI other than improving the general condition, stabilizing the spine, and reducing the compression of the spinal cord. 9 Surgical decompression within 24 h of a SCI does, however, facilitate sensorimotor recovery.…”

Section: Introductionmentioning

confidence: 99%

Biomaterials delivery strategies to repair spinal cord injury by modulating macrophage phenotypes

et al. 2022

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Spinal cord injury (SCI) causes tremendous harm to a patient’s physical, mental, and financial health. Moreover, recovery of SCI is affected by many factors, inflammation is one of the most important as it engulfs necrotic tissue and cells during the early stages of injury. However, excessive inflammation is not conducive to damage repair. Macrophages are classified into either blood-derived macrophages or resident microglia based on their origin, their effects on SCI being two-sided. Microglia first activate and recruit blood-derived macrophages at the site of injury—blood-borne macrophages being divided into pro-inflammatory M1 phenotypes and anti-inflammatory M2 phenotypes. Among them, M1 macrophages secrete inflammatory factors such as interleukin-β (IL-β), tumor necrosis factor-α (TNF-α), IL-6, and interferon-γ (IFN-γ) at the injury site, which aggravates SCIs. M2 macrophages secrete IL-4, IL-10, IL-13, and neurotrophic factors to inhibit the inflammatory response and inhibit neuronal apoptosis. Consequently, modulating phenotypic differentiation of macrophages appears to be a meaningful therapeutic target for the treatment of SCI. Biomaterials are widely used in regenerative medicine and tissue engineering due to their targeting and bio-histocompatibility. In this review, we describe the effects of biomaterials applied to modulate macrophage phenotypes on SCI recovery and provide an outlook.

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Spinal cord pathology revealed by MRI in traumatic spinal cord injury

Cited by 5 publications

References 47 publications

Traumatic Spinal Cord Injury

Traumatic Spinal Cord Injury

Hydrogel and Nanomedicine‐Based Multimodal Therapeutic Strategies for Spinal Cord Injury

Biomaterials delivery strategies to repair spinal cord injury by modulating macrophage phenotypes

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