[show abstract][hide abstract] ABSTRACT: Los cordomas son tumores poco frecuentes que pueden presentarse en cualquier parte de la columna vertebral y en el clivus. Sólo un mínimo porcentaje de estos tumores afectan el área lumbar. En este escrito presentamos un caso de cordoma lumbar y discutimos su presentación clínica, radiológica y las opciones de tratamiento.
Neurocirugía: Organo oficial de la Sociedad Española de Neurocirugía, ISSN 1130-1473, Vol. 16, Nº. 2, 2005, pags. 169-172. 07/2013;
[show abstract][hide abstract] ABSTRACT: Spinal cord injury is a devastating, traumatic event, and experienced mainly among young people. Until the modern era, spinal cord injury was so rapidly fatal that no seriously injured persons would survive long enough for regeneration to occur. Treatment of spinal cord injury can be summarized as follows: prevent further cord injury, maintain blood flow, relieve spinal cord compression, and provide secure vertebral stabilization so as to allow mobilization and rehabilitation, none of which achieves functional recovery. Previous studies have focused on analyzing the pathogenesis of secondary injury that extends from the injury epicenter to the periphery, as well as the tissue damage and neural cell death associated with secondary injury. Now, there are hundreds of current experimental and clinical regenerative treatment studies. One of the most popular treatment method is cell transplantation in injured spinal cord. For this purpose bone marrow stromal cells, mononuclear stem cells, mesenchymal stem cells, embryonic stem cells, neural stem cells, and olfactory ensheathing cells can be used. As a result, cell transplantation has become a promising therapeutic option for spinal cord injury patients. In this paper we discuss the effectiveness of stem cell therapy in spinal cord injury.
Current Stem Cell Research & Therapy 07/2012; 7(5):364-9. · 2.96 Impact Factor
[show abstract][hide abstract] ABSTRACT: The aim of this study was to address the question of whether bone marrow-originated mononuclear cells (MNC) or mesenchymal stem cells (MSC) induce neural regeneration when implanted intraspinally.
The study design included 4 groups of mice: Group 1, non-traumatized control group; Groups 2, 3 and 4 spinal cord traumatized mice with 1 g force Tator clips, which received intralesionally either no cellular implants (Group 2), luciferase (Luc) (+) MNC (Group 3) or MSC (Group 4) obtained from CMV-Luc or beta-actin Luc donor transgenic mice. Following the surgery until decapitation, periodical radioluminescence imaging (RLI) and Basso Mouse Scale (BMS) evaluations was performed to monitor neural activity. Postmortem immunohistochemical techniques were used to analyze the fate of donor type implanted cells.
All mice of Groups 3 and 4 showed various degrees of improvement in the BMS scores, whereas there was no change in Groups 1 and 2. The functional improvement was significantly better in Group 4 compared to Group 3 (18 vs 8, p=0.002). The immunohistochemical staining demonstrated GFP(+)Luc(+) neuronal/glial cells that were also positive with one or more of these markers: nestin, myelin associated glycoprotein, microtubule associated protein or myelin oligodendrocyte specific protein, which is considered as indicator of donor type neuronal regeneration. Frequency of donor type neuronal cells; Luc + signals and median BMS scores were observed 48-64% and 68-72%; 44-80%; 8 and 18 within Groups III and IV respectively.
MSCs were more effective than MNC in obtaining neuronal recovery. Substantial but incomplete functional improvement was associated with donor type in vivo imaging signals more frequently than the number of neuronal cells expressing donor markers in spinal cord sections in vitro. Our results are in favor of functional recovery arising from both donor MSC and MNCs, contributing to direct neuronal regeneration and additional indirect mechanisms.
[show abstract][hide abstract] ABSTRACT: The lumbosacral intrathecal anatomy is complex because of the density of nerve roots in the cauda equina. Space-occupying lesions, including disc herniation, trauma and tumor, within the spinal canal may compromise the nerve roots, causing severe clinical syndromes. The goal of this study is to provide spinal surgeons with a detailed anatomical description of the intrathecal nerve roots and to emphasize their clinical importance.
Ten formalin-fixed male cadavers were studied. They were dissected with the aid of a surgical microscope, and measurements were performed.
The number of dorsal and ventral roots ranged from one to three. The average diameter of roots increased from L1 to S1 (0.80 mm for L1 and 4.16 for S1), respectively. Then their diameter decreased from S1 to S5 (4.16 mm for S1, 0.46 mm for S5). The largest diameter was found at S1 and the smallest at S5. The average number of rootlets per nerve root increased from L1 to S1, then decreased (3.25 for L1, 12.6 for S1, and 1.2 for S5), respectively. The greatest rootlet number was seen at S1, and the fewest were observed at S5. The average diameter of the lateral recess gradually decreased from L1 to L4 (9.1 mm for L1; 5.96 mm for L4) and then increased at L5 level (6.06 mm); however, the diameter of the nerve root increased from L1 to L5. The midpoint of distance between the superior and inferior edge of the intradural exit nerve root was 3.47 mm below the inferior edge of the superior articular process at the L1 level, while the origin of the L5 exit root was 5.75 mm above the inferior edge. The root origin gradually ascended from L1 to L5.
The findings of this study may be valuable for understanding lesions compressing intradural nerve roots and may be useful for intradural spinal procedures.
[show abstract][hide abstract] ABSTRACT: The formation of bacterial biofilm on the surface of implanted metal objects is a major clinical problem. The antibacterial and antifungal effect of silver ions has been long known, and seems to give silver the capability to inhibit biofilm formation. To test the effect of silver ions, 20 New Zealand rabbits had bacteria applied to a screw insertion site at the iliac crest, and were then randomly divided into two groups: Group I, which had silver-coated screws applied, and Group II, which had uncoated titanium screws. After the rabbits were sacrificed on day 28, we examined the screws, the bone adjacent to the screws, and the liver, kidneys, brain and corneas of both groups under transmission (TEM) and scanning electron microscopy (SEM). We also analysed microbiological samples from the screw holes. All silver-coated screws, but only 10% of uncoated titanium screws, were sterile. All tissue samples appeared ultrastructurally normal in both groups. Biofilm formation was inhibited on all silver-coated screws, but all uncoated screws developed a biofilm on their surfaces. Our findings suggest that nanoparticle silver ion-coated implants are as safe as uncoated titanium screws and that they can help prevent both biofilm formation and infection.
Journal of Clinical Neuroscience 03/2011; 18(3):391-5. · 1.25 Impact Factor
[show abstract][hide abstract] ABSTRACT: Although infrequent, injury to adjacent neurovascular structures during posterior approaches to lumbar intervertebral discs can occur. A detailed anatomical knowledge of relationships may decrease surgical complications.
Ten formalin-fixed male cadavers were used for this study. Posterior exposure of the lumbar thecal sac, nerve roots, pedicles, and intervertebral discs was performed. To identify retroperitoneal structures at risk during posterior lumbar discectomy, a transabdominal retroperitoneal approach was performed, and observations were made. The distances between the posterior and anterior edges of the lumbar intervertebral discs were measured, and the relationships between the disc space, pedicle, and nerve root were evaluated.
For right and left sides, the mean distance from the inferior pedicle to the disc gradually increased from L1-2 to L4-5 (range 2.7-3.8 mm and 2.9-4.5 mm for right and left side, respectively) and slightly decreased at L5-S1. For right and left sides, the mean distance from the superior pedicle to the disc was more or less the same for all disc spaces (range 9.3-11.6 mm and 8.2-10.5 mm for right and left, respectively). The right and left mean disc-to-root distance for the L3-4 to L5-S1 levels ranged from 8.3 to 22.1 mm and 7.2 to 20.6 mm, respectively. The root origin gradually increased from L-1 to L-5. The right and left nerve root-to-disc angle gradually decreased from L-3 to S-1 (range 105°-110.6° and 99°-108°). Disc heights gradually increased from L1-2 to L5-S1 (range 11.3-17.4 mm). The mean distance between the anterior and posterior borders of the intervertebral discs ranged from 39 to 46 mm for all levels.
To avoid neighboring neurovascular structures, instrumentation should not be inserted into the lumbar disc spaces more than 3 cm from their posterior edge. Accurate anatomical knowledge of the relationships of intervertebral discs to nerve roots is needed for spine surgeons.
Journal of neurosurgery. Spine 02/2011; 14(5):630-8. · 1.61 Impact Factor
[show abstract][hide abstract] ABSTRACT: Spinal cord injury is common among young subjects involved in motor vehicle accidents. Mechanisms and attempts to reverse post-traumatic pathophysiologic consequences are still being investigated. Unfortunately no effective and well-established treatment modality has been developed so far. The regeneration capability of the human nervous system following an injury is highly limited.
The study involved four patients (two male, two female) who had suffered spinal cord injury as a result of various types of trauma. On neurologic examination, all the patients were determined to be in American Spinal Injury Association (ASIA) grade A. All patients were treated with decompression, stabilization and fusion for vertebral trauma anteriorly, as well as intralesional implantation of cellular bone marrow concentrates using a posterior approach 1 month after the first operation. The patients were then treated and followed-up in the physical rehabilitation clinic.
At the end of the post-operative 1-year follow-up, two of the patients were classified as ASIA C while one was classified as ASIA B. One patient showed no neurologic change; none of the patients suffered from any complications or adverse effects as a result of intralesional application of bone marrow cells.
The results of this experimental study show the potential contribution of intralesional implantation of bone marrow to neuronal regeneration in the injured spinal cord, with neuronal changes. In light of the results of this experimental study, the potential for regenerative treatment in injuries of the human spinal cord is no longer a speculation but an observation.
[show abstract][hide abstract] ABSTRACT: Bio-implants in the human body act as passive surfaces that are prone to bacterial adhesion potentially leading to deep body infections. Pedicle screws made of uncoated or silver-coated titanium alloy were used both in vitro and in vivo to determine whether silver-coated materials have antimicrobial properties when they are anodized. Twenty-four New Zealand Albino rabbits were divided into four groups with six in each. In Group 1, the rabbits were exposed to 8 muA direct current (DC) via silver-coated screws. In Group 2, the rabbits were not exposed to any electrical current, but silver-coated screws were used. In Group 3, the rabbits were exposed to 8 muA DC using uncoated screws. In Group 4, the rabbits were not exposed to any electrical current, but uncoated screws were used. Staphylococcus aureus (106 cfu) was inoculated into the rabbits before any electrical current was applied. All the animals were killed, and the areas surrounding the screws were histologically and microbiologically examined. Silver-coated titanium screws prevented implant-associated deep bone infections when they were polarized anodically. The antibacterial effects of the same screws with the same bacterium were confirmed in in vitro experiments on agar plates. When the screws were anodized with the same electrical parameters in vitro, a marked inhibition zone was detected around the silver-coated screws but not around the uncoated screws. Our findings suggest that silver-coated titanium implants can be used to prevent implant-associated deep bone infections when they are polarized anodically.
Journal of Clinical Neuroscience 05/2008; 15(4):434-9. · 1.25 Impact Factor
[show abstract][hide abstract] ABSTRACT: The report aimed to present the outcome of surgical management of spinal synovial cyst.
The study was a retrospective review of six patients surgically treated between January 2005 and September 2007. The patients were evaluated in preoperative and postoperative periods. Evaluation was done by questionnaire scoring system. According to this system, categories were; excellent,good, fair, and poor.
The duration of follow-up ranged between 3 months and 42 months (mean: 23.3 months; SD: 13.0). Synovial cysts were located in the lumbar spine in 4 of 6 patients. In the other 2 patients, they were in the cervical and thoracal regions. Three patients were female, and three were male. The results of the lumbar group were better than those of the other groups in early period. The findings of the follow-up evaluations were better than those determined in the early postoperative period in all the groups.
Surgery is an effective treatment for spinal synovial cysts, especially for lumbar synovial cysts.
[show abstract][hide abstract] ABSTRACT: Multiple sclerosis (MS) may sometimes present as a mass lesion that is clinically and radiologically indistinguishable from brain tumor. The initial recognition of such cases is essential to avoid a surgical intervention and supplementary treatment. Sometimes areas adjacent to a tumor may present similar histopathological features with non-neoplastic demyelinating lesions. Thus, the proper preparation of the specimen is the key for correct pathological diagnosis. We report a case of MS with large cranial involvement showing a mass effect. The operative procedure associated with medical treatment was performed, and a good result was obtained. Our case presentation and others in the literature suggest strategies for detecting MS presenting as a mass lesion.
[show abstract][hide abstract] ABSTRACT: There have been few anatomic studies on the foramina and roots of the lumbar region, and those available in human specimens are usually based on computed tomography and magnetic resonance imaging methods.
Using the recent breakthroughs in microscopic anatomic dissections, the roots and vertebral foramina of the lumbar region were examined in 15 cadavers. Morphometric analysis of the roots and vertebral foramina of 80 lumbar vertebral objects was conducted.
The transverse and sagittal diameters of the lumbar intervertebral foramina were measured at each vertebral level. The median diameter of the lumbar neural foramina was 8.8 +/- 1.7 mm for the transverse and 19.4 +/- 2.7 mm for the sagittal planes. The widest median diameter of roots was 3.9 mm in the L4 root, and the narrowest was 3.3 mm in the L1 root.
Quantitative measurements of the diameters of the neural foramina and roots of the lumbar region in anatomic dissection models may provide a deeper understanding about the pathologies of this region and influence the success of surgical interventions.
[show abstract][hide abstract] ABSTRACT: Two patients presented with congenital basilar invagination manifesting as progressive myelopathy. Both patients underwent surgery using a neuronavigation-assisted transoral-transpharyngeal approach. The Brain-LAB Vector Vision navigation system was used for image guidance. The registration accuracies were 0.9 and 1.3 mm. After decompression, posterior stabilization was performed. Both patients had an uneventful postoperative course. The transoral-transpharyngeal approach with the neuronavigation system provides safe exposure and decompression for basilar invagination.
[show abstract][hide abstract] ABSTRACT: To investigate the effect of titanium ring cage implantation on cervical foraminal area and intervertebral height.
Twenty-two patients with single level cervical disc herniation were enrolled in this study. All patients underwent a standard anterior cervical discectomy followed by titanium ring cage implantation. Radiographs were used for evaluation of the cervical foraminal area and intervertebral height in the pre- and postoperative periods.
Mean intervertebral heights were 0.7 +/- 0.1 cm (preoperative), 1.1 +/- 0.2 cm (early postoperative) and 0.9 +/- 0.2 (final measurement). Increase in intervertebral height at final follow-up was 0.2+/-0.1 cm (22.6+/-8.5%). Mean cervical foraminal areas were 0.4+/-0.1 cm2 (preoperative), 0.5 +/- 0.2 cm2 (early postoperative) and 0.5 +/- 0.1 cm2 (final measurement). Increase in cervical foraminal area at the final follow-up was 0.1 +/- 0.1 cm2.
Our study demonstrates that cervical intervertebral height and cervical foraminal area significantly increased after cervical ring cage placement but subsidence during the follow-up period negatively affects foraminal area. However, overall, there was a relative increase of foraminal area and intervertebral height when compared with preoperative values. Long-term follow-up is required to further assess the subsidence rate.
Journal of Clinical Neuroscience 03/2006; 13(2):228-32. · 1.25 Impact Factor
[show abstract][hide abstract] ABSTRACT: Chordomas are rare tumors and they may arise anywhere along the spinal column and clival bone. The vast majority of tumors are found at skull base and sacrum. Chordomas involving the lumbar spine are rare. Approximately 6% of spinal chordomas originate in the lumbar vertebrae. We report a case of this chordoma arising from the lumbar vertebra.
[show abstract][hide abstract] ABSTRACT: Apoptosis has increasingly been considered as an important factor in secondary injury after spinal cord injury (SCI). Manifestation of apoptotic cell death process involves activation of the caspase-3 apoptotic cascade. The aim of the study was to demonstrate the effect of magnesium sulfate on caspase-3 activity and to compare its effectiveness with methylprednisolone after acute SCI.
The rats were randomly and blindly allocated into 5 groups of 8 rats each. Spinal cord contusion injury was produced by the weight drop method. The control group consisted of non-injured rats. In the trauma group, no treatment was given, whereas 1 mL saline, 600 mg/kg magnesium sulfate, and 30 mg/kg methylprednisolone sodium succinate (MPSS) were administered in the vehicle and both treatment groups immediately after injury. Twenty-four hours after trauma, spinal cord samples were obtained, and tissue caspase-3 activity levels were examined. A 1-way analysis of variance and the post hoc test were used for statistical analysis.
The results showed that caspase-3 activity increased to statistically significantly higher levels in spinal cord after contusion injury than in the control group. Caspase-3 enzyme activity levels were significantly reduced in animals treated either with magnesium sulfate or MPSS.
We have shown that magnesium sulfate decreases caspase-3 activity in rat spinal cord subjected to contusion injury. Magnesium sulfate may have potential therapeutic benefits by reducing apoptotic tissue damage after SCI.
[show abstract][hide abstract] ABSTRACT: Spinal cord injury (SCI) is a common and often irreversible lesion that can incapacitate patients. Precursor cells in the spinal cord proliferate in response to trauma, and this proliferation can be enhanced by exogenous stimuli such as specific growth factors. In the present study, we examined electron microscopic detection of the proliferation, distribution, and phenotypic fate of these precursor cells in the injured adult rat spinal cord.
Adult female Sprague-Dawley rats weighing 250 to 300 g were divided into 3 groups. The first group consisted of spinal cord-injured animals with application of a 2.4-g clip extradurally around the spinal cord at the T1 level. A 26-g clip was applied in the second group. The third group included normal uninjured animals. Rats were sacrificed at 3 days, 3 weeks, and 6 weeks after injury. A segment of the spinal cord, 0.4 cm in length, encompassing the injury site was removed and was prepared for electron microscopy.
Three days after mild injury (2.4-g clip), ependymal cells had begun to proliferate and had migrated from the central canal. They had a tendency to surround perivascular spaces close to the axons. The central canal rostral to the lesion site was widely dilated at 6 weeks postoperative in the moderately injured groups (26-g clip). The layer of ependymal cells lining the dilated canal showed reduction in cell height. Traumatic syringomyelic cavities were observed in all of the animals. There was an active proliferative response of the ependymal cells to injury. Large clusters of displaced ependymal cells associated with the dilated central canal were observed. Rests of ependymal cells were observed remote from the central canal with a tendency to form rosettes and accessory lumina 6 weeks after trauma. Fascicles of 3 to 8 fibers enclosed within an ependymal cell were a common finding among the ependymal clusters. There were also debris and some ependymal cells in the lumen.
Trauma induces active proliferation of precursor cells in the ependymal region. These cells may replace neural tissue lost to SCI and may assist in axonal regeneration.
[show abstract][hide abstract] ABSTRACT: We report a rare case of schwannoma of the conus medullaris. A 38-year-old female presented with pain and numbness in her lower limbs. Magnetic resonance imaging confirmed a heterogenous tumour of the conus medullaris. A subtotal resection was performed and histology confirmed schwannoma. The literature regarding these rare tumours, and their cell of origin, is reviewed.
Journal of Clinical Neuroscience 02/2005; 12(1):80-1. · 1.25 Impact Factor