Surgical Considerations to Improve Recovery in Acute Spinal Cord Injury

Tabarestani, Troy Q.; Lewis, Nicholle E.; Kelly-Hedrick, Margot; Zhang, Nina; Cellini, Brianna R.; Marrotte, Eric J.; Williamson, Theresa; Wang, Haichen; Laskowitz, Daniel T.; Faw, Timothy D.; Abd-El-Barr, Muhammad M.

doi:10.14245/ns.2244616.308

Cited by 9 publications

(3 citation statements)

References 154 publications

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“…As previously mentioned, reduced vertebral BMD can make it challenging to perform surgical interbody fusion as the weak bone structure can increase the risk of implant-related complications such as cage subsidence after the procedure. Fusion construct length, selection of screws, choice of bone grafts, preparation methods, utilization of intervertebral prostheses (IVPs), extent and type of neural decompression, and management of neural damage, while considering extraspinal trauma and existing comorbidities, represent significant considerations in lumbar fusion [62,63].…”

Section: Figure 1: Decision Algorithm Of Pharmacological Agents For P...mentioning

confidence: 99%

The Role of Bone Mineral Density in a Successful Lumbar Interbody Fusion: A Narrative Review

Bekas,

Zafeiris

2024

Cureus

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Background: The incidence of osteoporosis is a prime concern, especially in parts of the world where the population is aging, such as Europe or the US. Many new therapy strategies have been described to enhance bone healing. Lumbar interbody fusion (LIF) is a surgical procedure that aims to stabilize the lumbar spine by fusing two or more vertebrae using an interbody cage. LIF is a standard treatment for various spinal conditions, such as degenerative disc disease, spinal stenosis, and spondylolisthesis. However, successful fusion is challenging for patients with osteoporosis due to their reduced bone mineral density (BMD) and increased risk of cage subsidence, which can lead to implant failure and poor clinical outcomes. Methods: A comprehensive literature search yielded 220 articles, with 16 ultimately included. Keywords included BMD, cage subsidence, osteoporosis, teriparatide, and lumbar interbody fusion. Results: This review examines the relationship between BMD and LIF success, emphasizing the importance of adequate bone quality for successful fusion. Preoperative assessment methods for BMD and the impact of low BMD on fusion rates and patient outcomes are discussed. Additionally, techniques to improve fusion success in patients with weakened bone density, such as biological enhancement and BMD-matched interbody cages, are explored. However, consensus on the exact BMD threshold for a successful outcome remains elusive. Conclusion: While an apparent correlation between BMD and fusion rate in LIF procedures is acknowledged, conclusive evidence regarding the precise BMD threshold indicative of an increased risk of unfavorable outcomes remains elusive. Surgeons are advised to exercise caution in surgical planning and follow-up for patients with lower BMD. Furthermore, future research initiatives, particularly longitudinal studies, are encouraged to prioritize the examination of BMD as a fundamental risk factor, addressing gaps in the literature.

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Section: Figure 1: Decision Algorithm Of Pharmacological Agents For P...mentioning

confidence: 99%

The Role of Bone Mineral Density in a Successful Lumbar Interbody Fusion: A Narrative Review

Bekas,

Zafeiris

2024

Cureus

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“…2.1 Theoretical Framework 2.1.1 International Classification of Functioning, Disability and Health (ICF) Bio-Psychosocial Models of Functioning The bio-psycho-social model suggests spinal cord injuries consist of impaired neuro-musculoskeletal systems of the biological structure of the bone and nerves with impaired loco-motor systems, with resultant restrictions to functional activities and participation (Mathew et al, 2001). The model addresses the consequences of fractures and spinal cord injuries during conservative management and after surgical repair and considers the short-and long-term functional impairments requiring physiotherapy rehabilitation programs (Tabarestani et al, 2022). While emphasizing the role of biological, psychological, and social aspects in determining the use of outcome measure tools in acute and long-term functional rehabilitation domains.…”

Section: Literature Reviewmentioning

confidence: 99%

Physiotherapists’ Use of Outcome Measure Tools in the Assessment of Neuro-Musculoskeletal Injuries for Short-Term Functional Rehabilitation Domains to Minimize Impairments and Disability following Commercial Motorcycle Road-Related Accident, Eldoret, Kenya

Muia,

Masinde,

Imbwaga

2024

AJERNET

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Bed immobilization remains a core intervention to stabilize neuro-musculoskeletal injuries following commercial motorcycle-related road traffic accidents. Despite timely operative and conservative management, most patients remain handicapped, requiring short- and long-term physical therapy. That calls for physiotherapists to assess and make use of outcome measure tools to determine the level of impairments and disability and make informed decisions when developing management goals. The objective of the study was to determine short-term functional rehabilitation domains, the use of outcome measure tools, and physiotherapy interventions used to minimize impairments and disability following a commercial motorcycle road-related accident in Eldoret, Kenya. Biopsychosocial theory guided the study. A prospective cohort study was adopted. Purposive sampling was used for the selection of 79 participants for 6 months between March 2021 and July 2021 in level 5 hospitals in Eldoret, Kenya. The target population included post-operative patients in both male and female orthopedics wards, physiotherapists, and social workers in the orthopedic department of Moi Teaching and Referral Hospital. The study population was 150 patients. A self-administered, structured questionnaire was used. The data collected was entered and analyzed with SPSS 20. The findings of this study revealed that forty-four percent (44%) of total participants were bedridden for fracture immobilization and spinal cord injuries for more than 3 days before and after orthopedic and neurological surgery. The majority (100%) of the participants had been referred for physiotherapy rehabilitation. All 100 participants were assessed with different outcome measure tools for neuro-musculoskeletal injuries to determine the level of physical function. Forty-three percent (43%) had lost functional abilities of the upper extremity (19 males, 15 females). Fifty-one-point nine percent (51.9%) had lost physical function due to lower extremity fractures (39% (26 males, 15 females) and 24% (15 males, 4 females) with spinal cord injuries. Four participants (5%) reported lost days to school, and 94.9% reported lost days to income-generating activities (27 females, 48 males). The majority (100%) of the participants pre- and post-operatively were assessed with standardized outcome measure tools that remain significant for prompt best evidence-based physiotherapy practices. Pain (100%) and impaired physical functions (100%) were the main rehabilitation domains that posed the biggest challenge to patients’ post-trauma. Multicomponent physiotherapy interventions ranging from stretching, strengthening, breathing exercises, bed positioning, mobility and transfers, balance and coordination, and gait training tailored to patients’ physical function levels, prevention of muscle atrophy and strength, and joint stiffness were core. This study recommended short-term physiotherapy rehabilitation on early bed mobilization and ambulation for patients, which remains core for the restoration of physical functional levels and a return formula to socioeconomic status.

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“…The affected individual’s resulting inability to work (labor) and the costs of long-term treatment impose a heavy financial burden on their family and the wider community [ 1 ]. Despite concerted efforts focused on SCIs in global terms, no effective breakthrough has yet been made toward a cure for the neurological dysfunction caused by an SCI [ 2 , 3 ]. Thus, it is imperative to further explore the pathophysiological mechanism of and to develop effective rehabilitation strategies for SCIs [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Electroacupuncture-Modulated MiR-106b-5p Expression Enhances Autophagy by Targeting Beclin-1 to Promote Motor Function Recovery After Spinal Cord Injury in Rats

Guo¹,

Chen²,

Yang³

et al. 2023

Neurospine

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Objective: Electroacupuncture (EA) has a definite effect on the treatment of spinal cord injuries (SCIs), but its underlying molecular mechanism remains unclear. Meanwhile, MiR106b-5p is an autophagy- and apoptosis-related microribonucleic acid, but whether it regulates the progression of autophagy and apoptosis in SCIs is yet undetermined. As such, this study aimed to elucidate the involvement of miR-106b-5p in the EA treatment of an SCI.Methods: The miR-106b-5p level was detected by quantitative real-time polymerase chain reaction. In vitro, SH-SY5Y cells were transfected with miR-106b-5p mimics or inhibitors to regulate the miR-106b-5p expression, while <i>in vivo</i>, SCI rats were treated with EA for 7 days at the bilateral Zusanli (ST36) and Jiaji (EX-B2) acupoints. The motor function was evaluated using the Basso-Beattie-Bresnahan (BBB) criteria. Further, autophagic vacuoles, pathological damage, and neuronal cell morphology were observed by transmission electron microscopy, as well as by hematoxylin and eosin and Nissl staining, respectively.Results: The miR-106b-5p level, which can interact directly with Beclin-1 by influencing its expression, as well as the expressions of P62, Caspase-3, and Bax, was upregulated after an SCI, but it decreased after EA. Moreover, the ratio of LC3-II to LC3-I was upregulated after EA. EA can enhance autophagy, reduce neuronal apoptosis, and minimize motor dysfunction and histopathological deficits after an SCI. More importantly, however, all the above effects induced by EA can be reversed after an injection of miR-106-5p agomir to produce an overexpression of miR-106b-5p.Conclusion: EA treatment could downregulate miR-106b-5p to alleviate SCI-mediated injuries by promoting autophagy and inhibiting apoptosis.

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Surgical Considerations to Improve Recovery in Acute Spinal Cord Injury

Cited by 9 publications

References 154 publications

The Role of Bone Mineral Density in a Successful Lumbar Interbody Fusion: A Narrative Review

The Role of Bone Mineral Density in a Successful Lumbar Interbody Fusion: A Narrative Review

Physiotherapists’ Use of Outcome Measure Tools in the Assessment of Neuro-Musculoskeletal Injuries for Short-Term Functional Rehabilitation Domains to Minimize Impairments and Disability following Commercial Motorcycle Road-Related Accident, Eldoret, Kenya

Electroacupuncture-Modulated MiR-106b-5p Expression Enhances Autophagy by Targeting Beclin-1 to Promote Motor Function Recovery After Spinal Cord Injury in Rats

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