spinal cord

Primary spinal tumors are rare, and epidemiologic studies on this topic are limited. These tumors may originate from the spinal cord, cauda equina, or spinal meninges. Various factors, including age and sex, influence the epidemiology of primary spinal tumors.

This study provides a descriptive report on the epidemiology of primary spinal tumors in Fars province, southern Iran.

We retrospectively collected data from patients with primary spinal tumors who underwent surgery at major neurosurgery centers in Fars province from 2001 to 2019. Descriptive statistics were used to analyze data concerning sex, age, tumor histology, and behavior.

The study included 166 patients with primary spinal tumors. The mean age of the patients was 41.9 years (SD, 17.1 years), with 55.4% being female. Among the patients, 66.9% had spinal cord tumors, 25.9% had tumors of the spinal meninges, and 7.2% had tumors in the cauda equina. Most tumors were intradural extramedullary (45.2%), followed by intramedullary tumors (42.2%) and extradural tumors (12.7%). Of the total, 76 tumors (45.8%) were classified as malignant, while 90 tumors (54.2%) were non-malignant. The most frequent histological types were ependymoma (24.1%), nerve sheath tumors (22.3%), and meningioma (20.5%). An increase in the relative incidence of astrocytic and ependymal tumors was observed compared to previous studies conducted in the same region.

This study presents a comprehensive epidemiologic report on primary spinal tumors in Fars province, Iran. Further nationwide studies, including all diagnosed spinal tumors, are recommended.

Rotenone is commonly used for Parkinson's disease (PD) experimental models based on selective neurodegeneration of midbrain dopaminergic neurons and motor dysfunctions. Meanwhile, rotenone is a toxic compound that causes high mortality, requiring a more significant number of experimental animals. Differences between male and female species in response to rotenone toxicity were reported, stating higher sensitivity in males than in females. In spite of the suggested various doses of rotenone, it is essential to regulate its dosage, especially when male and female species are involved in the experiments. The present study aimed to determine the optimal dose and duration of chronic rotenone injections in rats to achieve a relatively lower mortality rate.

Male and female albino rats were treated with moderate (2 mg/kg/day) and low (0.3-0.5 mg/kg/day) rotenone at different regimens. The brain (substantia nigra, striatum) and spinal cord were analyzed for neurodegeneration using H&E staining. The body weight and mortality of rats were monitored on a daily basis.

Comparative studies indicated that low doses of systemic rotenone injections were less toxic to females than to male rats. Female rats were more sensitive to chronic rotenone exposures, indicated by aggressive and anxious behavior. Nonetheless, the lower mortality rate in female than that in male rats suggested distinct physiological mechanisms to play a role in reduced rotenone toxicity in female rats.

These observations should be considered when male and female rats are involved in PD modeling. The diverse responses to neurotoxin are essential to provide a valid platform for further treatment schemes and clinical outcomes.

Considering that trauma is one of the important causes of death, especially head and neck trauma, knowledge of the epidemiology of trauma can be of great help in making management decisions. This study examined the 5-year epidemiology of head, neck, and spinal cord injuries in West Azerbaijan province.

In this descriptive cross-sectional study, 6,336 trauma patients who resided in the province of West Azerbaijan were included between 2019 and 2023. The province's national trauma registration program provided the data collection form. Individuals whose medical records were incomplete were not included.

The mean age of the patients was 33.39 years. The most common cause of trauma was road traffic accidents (38.3%, N = 2429), followed by falls (23.1%, N = 1461). At the moment of the accident, 107 patients were using alcohol, 45 patients had drug abuse, and 56 patients took tranquilizers like benzodiazepine; in total, 443 patients needed transfusion. The mean stay at the ICU and hospital was 8.49 ± 3.76 days and 5.05 ± 1.25 days, respectively. Many of the injured patients had a moderate (46.4%) and minor (31.1%) Abbreviated Injury Scale (AIS) in the assessment, in which male gender had poor condition in this regard (p < 0.001).

There are many injured individuals with low levels of education, indicating the urgent need to raise awareness among this group to help prevent road accidents. Post-trauma measures are clearly important, particularly in the fields of orthopedics, general surgery, and head and neck trauma.

Gum arabic (GA) contains anti-oxidant and anti-inflammatory compounds and protects tissues.

The purpose of the present study was to investigate the protective effect of GA on the spinal cord’s motor neurons after ischemia-reperfusion (I-R) injury.

Thirty-five male rats (Sprague-Dawley) were randomly divided into five groups: Intact, sham surgery, control (4 mL/kg distilled water+I/R), low-dose gum arabic (GA 1 g/kg+I-R), and high-dose gum arabic (GA 4 g/kg+I-R). In the experimental groups, oral gavages’ treatment was performed for 21 days before surgery. Three days after I-R, the rats were evaluated for neurological function, biochemical, and histological analysis.

The mean motor deficit index (MDI) in the GA groups versus the control group was significantly lower (P<0.01). About 72 hours after I-R, the mean plasma level of superoxide dismutase and total anti-oxidant capacity in the GA 4 g/kg group were higher than the control group (P<0.05). However, there was no significant difference in the plasma level of catalase between the GA 4 g/kg and the control groups (P<0.05). Approximately 67% of the motor neurons were destroyed in the control group, while this ratio was about 18% in the GA 4 g/kg group.

This study showed that GA (4 g/kg) protects the motor neurons of the spinal cord against ischemia-reperfusion injury.

Intramedullary spinal cord tumors (IMSCTs) are rare tumors of the spine. The study aims to analyze the clinical profile and surgical management of IMSCTs.

Methods and Materials/Patients:

 This is a retrospective study to review the IMSCTs operated between January 2007 to December 2021. Myxopapillary ependymomas were excluded from the study.

There were twenty-seven operated cases of IMSCTs. The Mean±SD age was 39±22 years. Fifteen (55.5%) were males and 12(44.5%) were female patients. There were 6(22%) cervical, 7(26%) cervicodorsal, 9 (33%) dorsal, and 5(19%) dorsolumbar IMSCTs. The Mean±SD duration of symptoms was 10±14 months. Ten (37%) patients had spinal cord syrinx. Motor weakness and pain were the most common symptoms. Intraoperative gross total resection (GTR) was achieved in 12(44.4%) patients, near-total resection in 4(14.8%) patients, subtotal resection in 2(7.4%) patients, decompression in 7(26%) patients, and biopsy in 2(7.4%) patients. Eighteen (66.6%) patients had neurological status same as preoperative status. Four (14.8%) patients had improvement and 5(18.5%) patients had deterioration in neurological status. Ependymoma was the most common histological type of IMSCT (40.5%). Other lesions are glioma, hemangioblastoma, lipoma, schwannoma, lymphoma, capillary hemangioma, arachnoid cyst, and epidermoid cyst with spinal dysraphism. Ependymomas had well-defined margins compared to other gliomas. Duration of stay in the hospital was 9±3.5 days.

Dorsal spine is the most common location of IMSCTs and ependymoma is the most common histological type. It is the surgeon’s intraoperative decision regarding the extent of resection of the tumor based on the spinal cord infiltration and tumor type. GTR is possible in the majority of ependymomas and some other histological tumors like schwannoma, arachnoid cyst, and epidermoid cyst.

Background and Importance:

 Neurenteric cysts (NCs) account for 0.7 to 1.3% of all spinal tumors and are most commonly present during the first three decades of life. Only two cases have been reported in individuals in their 7th and 8th decades of life. This study described a rare case of an NC in a septuagenarian (70 – 79 years of age) who presented with atypical features of the disease.

A 77-year-old female patient presented with acute onset paraparesis. Magnetic resonance imaging revealed a 13.6 × 14.1 × 15.4 mm intradural extramedullary cystic lesion, which was anteriorly located at the C7-D1 level. It was T1 hypointense, T2 hyperintense, and showed faint contrast enhancement at the junction between the cyst and the spinal cord. At surgery, a cyst with a greyish-white thin wall was noted in the spinal canal, displacing the spinal cord posteriorly. The cyst wall was partially excised, and a small portion adhering to the spinal cord was left behind. The histopathology report was consistent with an NC. At the 2-week follow-up, the patient’s lower limb strength had improved.

Although rare, NCs can present in the seventh decade of life. Magnetic resonance imaging may reveal unusual findings, like T1 hypointensity and faint contrast enhancement of the cyst wall. In elderly patients, a portion of the cyst wall may be left behind if it adheres to the spinal cord to avoid the risk of neurological deterioration.

In recent years, the convergence of medical research and digital technology has opened up new avenues for exploring intricate healthcare dynamics. Deep Vein Thrombosis, a potentially life-threatening condition characterized by the formation of blood clots in deep veins, is of paramount concern for surgical candidates due to the inherent immobilization associated with postoperative recovery. This study aimed to evaluate the utilization of digital platforms for investigating the frequency of Deep Vein Thrombosis among candidates for spinal surgery. This retrospective study, conducted at Hazrat Rasool Akram (PBUH) hospital, Tehran, Iran between February 2014 and February 2019, investigated Deep Vein Thrombosis (DVT) frequency among spinal surgery candidates using digital platforms. Electronic health records (EHR) were collected and preprocessed, integrating processed data on a secure cloud-based platform for collaborative access and advanced analytics. These records contain comprehensive information about a patient’s medical history, diagnoses, medications, treatment plans, immunization dates, allergies, radiology images, and laboratory test results. Collecting EHR involves gathering electronic data from various sources within the hospital database. After examining them, 218 patients were included in the present study. Data analysis entails STATA software, applying descriptive statistics, chi-square tests, and associations between ultrasound findings and clinical variables. The mean age of these patients was 49.22±11.22 years. The frequency of DVT in candidates for back surgery was 1.83%. Regarding D-dimer investigation, the results of our study showed that all 4 patients with DVT had high D-dimer, while only 34 patients of all patients without DVT had high D-dimer levels. The results showed that the presence of the history of hospitalization reduces the risk of DVT in patients who were candidates for back surgery (P=0.028), while the high level of serum D-dimer was an important warning sign for the occurrence of DVT in patients who were candidates for back surgery (P=0.001).  This study showcases the value of digital platforms in investigating Deep Vein Thrombosis frequency among spinal surgery candidates, highlighting the associations between D-dimer levels, medical history, and DVT risk. These findings offer insights that can inform clinical assessments and interventions for this patient population.

Percutaneous vertebroplasty employs bone cement for injecting into the fractured vertebral body (VB) caused by spinal metastases. Radioactive bone cement and also brachytherapy seeds have been utilized to suppress the tumor growth in the VB.
This study aims to investigate the dose distributions of low-energy brachytherapy seeds, and to compare them to those of radioactive bone cement, by Monte Carlo simulation.
In this simulation study, nine CT scan images were imported in Geant4. For the simulation of brachytherapy, I-125, Cs-131, or Pd-103 seeds were positioned in the VB, and for the simulation of vertebroplasty, the VB was filled by a radioactive cement loaded by P-32, Ho-166, Y-90, or Sm-153 radioisotopes. The dose-volume histograms of the VB, and the spinal cord (SC) were obtained after segmentation, considering that the reference dose is the minimum dose covered 95% of the VB.
The SC sparing was improved by using beta-emitting cement because of their steep gradient dose distribution. I-125 seeds and Y-90 radioisotope showed better VB coverage for brachytherapy and vertebroplasty techniques, respectively. Pd-103 seeds and P-32 radioisotope showed better SC sparing for brachytherapy and vertebroplasty, respectively. The minimum mean doses that covered 100% of the VB were 62.0%, 56.5%, and 45.0% for I-125, Cs-131, and Pd-103 seeds, and 28.3%, 28.6%, 32.9%, and 17.7%, for P-32, Ho-166, Y-90, and Sm-153 sources, respectively. 
I-125 and Cs-131 seeds may be useful for large tumors filling the entire VB, and also for the extended tumors invading multiple vertebrae. Beta-emitting bone cement is recommended for tumors located near the SC.

SARS-COV-2 can present with pulmonary, renal, gastrointestinal, hematological, and neurological manifestations. Neurological manifestations may occur after or before COVID-19 symptoms and signs. Spine and spinal cord complications are documented as neurological complications of COVID-19. Spinal cord pathology following COVID-19 showed inflammatory myelopathy and suspected cord ischemia. The most frequent presentation of COVID-19 myelitis is non-enhancing central expansile cord T2 signal changes, but it can present with lateral and dorsal column-specific disease and in some cases with negative magnetic resonance imaging (MRI). There is no known documented mechanism for spinal cord involvement in COVID-19 infection, but it seems as a post-infectious immunological and post-inflammatory disorder and reaction. Viral infection of SARS-CoV-2 can cause demyelination of the brain and spinal cord and also can exacerbate the known primary demyelinating disorders.

Methods and Materials/Patients:

 This is a narrative study about the spinal cord complications of COVID-19. To provide up-to-date information, we precisely reviewed COVID-19 articles on spine and spinal cord complications. Based on the keywords COVID-19, SARS-CoV-2, spine, and spinal cord, all the related articles were taken from Google Scholar, PubMed, and Medline and were precisely studied.

There are reported cases of COVID-19 spine and spinal cord involvement. There is no documented mechanism for these involvements but the possible mechanisms are direct invasion, cytokine storm, coagulopathy, and an autoimmune response. The routine therapy of such complications is the treatment of these complications with other primary causes with a poor and unsatisfactory response of myelopathy to treatment; however, early diagnosis and vigilance of such involvement improve outcome.

COVID-19 can cause spine and spinal cord complications in some patients without a known incidence rate of such complications. The pathogenesis is not completely known; therefore, more conclusive studies are obligatory to improve our information on COVID-19 spinal cord and spine complications.

In developing countries, treatment of cervical cancer with metastasis to the spinal cord is generally associated with failure and reduced patient survival due to the lack of appropriate facilities. Oncologists are using a variety of methods to prolong patient survival. In the present study, we aimed to estimate the three- and five-year disease-free survival of patients with cervical cancer and spinal cord metastasis, treated with external radiotherapy + brachytherapy (i.e., internal radiotherapy.

This descriptive cross-sectional study was performed over a period of ten years (2010-20) in the brachytherapy ward of Shahid Madani Hospital (Tabriz, Iran). Overall, 200 patients with cervical cancer and spinal cord metastasis who were candidates for external radiotherapy + brachytherapy were recruited by the census sampling method. The variables that were likely to affect survival were recorded and analyzed using the Koch survival test and relevant descriptive and inferential statistics in SPSS version 23 software.

The patients’ overall survival was 43.12 ± 1.44 months; 78 patients (39%) survived until the end of the third year, and 49 (24.5%) lived till the end of the fifth year. Also, the pathological diagnosis (P = 0.013- P = 0.015), disease stage (P = 0.014- P = 0.018), the length of the treatment area (P = 0.026- P = 0.044), and undergoing chemotherapy (P = 0.001- P = 0.002) were significantly associated with the survival of the patients who completed the treatment course.

Chemotherapy, advanced disease, and greater length of the treatment area reduced three- and five-year survival in the patients with cervical cancer and spinal cord metastasis who underwent brachytherapy.

 One of the consequences of life in today's society is the high prevalence of spinal cord injury, which happens for several reasons. Decreased mobility in these people causes premature fatigue and reduces their quality of life, which leads to diseases. This study aimed to compare the effectiveness of virtual reality-based rehabilitation exercises and reflexology in reducing the fatigue rate of paraplegic veterans.

 This quasi-experimental study was carried out on paraplegia veterans in Tehran province in 2020. Forty-five active paraplegia veterans with spinal cord injury and a history of regular exercise of with at least 2 years’ experience of regular participation in sport activities were randomly classified into three groups: virtual reality, reflexology, and control. The Functional Status Scale is a self-administered questionnaire that was used. Exercise programs were performed for three sessions per week for 30 minutes every other day for six weeks. A post-test was performed after the training sessions. Data were analyzed using SPSS 23 software by ANOVA test.

 The mean score of fatigue in the subjects was 45.86±13.57, which was obtained after a pre-test using the fatigue severity scale questionnaire. Findings showed that virtual reality exercises and reflexology had a significant effect on fatigue in paraplegia veterans (p<0.05). A significant difference was observed between both experimental and control groups after the intervention (p<0.05). The reduction of fatigue was also significant in the massage group (p<0.05).

 There is a reduction in Fatigue rate in Paralyzed Veterans in both massage and virtual reality groups compared to the control group.

Posterior reversible encephalopathy syndrome has a broad spectrum in clinical presentation and radiologic features. Diagnosis of posterior reversible encephalopathy syndrome (PRES) based on reversible clinical manifestations and sequential neuroimaging. Atypical MRI features were defined as hemorrhage, restricted diffusion or contrast enhancement of lesions, involvements of temporal and frontal lobes, brain stem, basal ganglia, corpus callosum, cerebellum, and spine. Atypical PRES with or without spinal cord involvement is a rare presentation, especially in children. Up to 2020, just 5 cases of posterior reversible encephalopathy syndrome with spinal cord involvement (PRES-SCI) have been published in pediatrics.

Brown-Sequard Syndrome (BSS) is a rare neurological condition resulting from a hemisection injury to or unilateral compression on the spinal cord. The common causes of BSS that are amenable to be treated surgically can be divided into traumatic and non-traumatic injuries. Traumatic injuries are often reported as the main cause of BSS. However, non-traumatic injuries of the spinal cord are more seen in recent years. This study aims to classify and update surgically treatable causes of BSS.

Retrospective data of 17 patients operated for BSS between 2008 and 2020 were included. The long-term outcomes of these patients were evaluated. In addition, a comprehensive search in PubMed, Scopus, and CINAHL was conducted for the retrieval of all relevant studies.

Magnetic Resonance Image (MRI) of our patients revealed Cervical Disc Herniation (CDH), spinal canal stenosis with cervical spondylosis, epidural hematoma, and ossification of the posterior longitudinal ligament. The postoperative outcomes of our cases ranged from partial to complete recovery. While the patients with acute epidural hemorrhage achieved complete recovery after surgery, neurological deficits in the other patients, especially those with severe cervical spinal canal stenosis, persisted despite adequate surgical decompression. The systematic literature review revealed that CDH is the most common non-traumatic surgically treatable cause of BSS, followed by spinal cord herniation and spinal epidural hematoma.

Non-traumatic injuries of the spinal cord accompanied by narrowed cervical spinal canal pathologies are prominent surgically treatable causes of BSS. Contrary to the definition made 100 years ago, BSS can occur spontaneously due to underlying pathologies rather than major traumatic injuries.

Many mechanisms are involved in pain transmission in the spinal cord. Therefore, combination of drugs acting on different kinds of mechanisms might be useful for analgesia. We investigated the interaction betweenγ-aminobutyric acid （GABA）B receptor agonist, baclofen, and N-methyl-D-aspartate （NMDA） receptor antagonist, AP-5, orα-amino-3-hydroxy-5-methylisoxazole-4-propionic acid （AMPA） receptor antagonist, YM-872, on analgesic effects in acute thermal and formalin induced pain models of rats.

Male Sprague-Dawley rats implanted with lumbar intrathecal catheters were given intrathecal baclofen, AP-5, YM872 or combination of baclofen and AP-5 or YM872, then tail flick test or formalin test was performed. Fifty % effective doses of combinations were obtained and isobolographic analysis was done.

The combination of baclofen and AP-5 or YM872 showed dose dependent increases in tail flick latency and decreases in flinching response in the formalin test. In the tail flick test, ED50s of the combination of baclofen + AP-5 or YM872 were close to the additive points. In both phases of the formalin test, ED50s of the combination of baclofen + AP-5 or YM872 were significantly lower than additive points.

For acute thermal pain, both AP-5 and YM872 had similar additive analgesic effects with baclofen. For chemical induced acute pain, both AP-5 and YM872 had similar synergistic analgesic effects with baclofen, but for facilitated pain, YM872 had stronger synergistic analgesic effects with baclofen than AP-5.

The knowledge of emergency medical technicians (EMTs) plays a crucial role in the prognosis of traumatic patients. This study aimed to assess the knowledge of pre-hospital care intensity index of spinal cord trauma amongst EMTs in Ilam, Iran. 

This cross-sectional study conducted on 98 EMTs based on census sampling method. Data were collected using a researcher-made questionnaire on pre-hospital care intensity index of spinal cord trauma and were analyzed using SPSS 16.

The EMTs’ knowledge of prehospital care intensity index of spinal cord trauma was %87.7 at advanced level and %15.3 at intermediate level, respectively. There was a significant relationship between technician’s knowledge score and such variables as their age, work record, overtime hours and number of missions(p˂0.05).

EMTs needed more specialized information on spinal trauma. It was recommended to hold in-service training programs more precisely and consider the training of necessary skills that a majority of EMTs are in need of.