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International Journal of Stroke :... Jun 2017Background Physical, psychological, and/or social impairment can result after a stroke and can be exacerbated by pain. One type of pain after stroke, central poststroke... (Review)
Review
Background Physical, psychological, and/or social impairment can result after a stroke and can be exacerbated by pain. One type of pain after stroke, central poststroke pain, is believed to be due to primary central nervous system mechanisms. Estimated prevalence of central poststroke pain ranges widely from 8% to 55% of stroke patients, suggesting a difficulty in reliably, accurately, and consistently identifying central poststroke pain. This may be due to the absence of a generally accepted definition. Aim We aimed to clarify the role of thalamic strokes and damage to the spinothalamic pathway in central poststroke pain patients. Also, we aimed to gain a current understanding of anatomic substrates, brain imaging, and treatment of central poststroke pain. Summary of review Two independent reviewers identified 10,144 publications. Based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we extracted data from 23 papers and categorized the articles' aims into four sections: somatosensory deficits, pathway stimulation, clinical trials, and brain imaging. Conclusions Our systematic review suggests that damage to the spinothalamic pathway is associated with central poststroke pain and this link could provide insights into mechanisms and treatment. Moreover, historical connection of strokes in the thalamic region of the brain and central poststroke pain should be reevaluated as many studies noted that strokes in other regions of the brain have high occurrence of central poststroke pain as well.
Topics: Brain; Clinical Trials as Topic; Humans; Pain; Pain Management; Spinothalamic Tracts; Stroke
PubMed: 28494691
DOI: 10.1177/1747493017701149 -
European Spine Journal : Official... Jun 2023This study aims to evaluate the efficacy and safety of spinal cord stimulation (SCS) compared to conventional medical management (CMM) for patients diagnosed with... (Meta-Analysis)
Meta-Analysis Review
Comparison of clinical outcomes associated with spinal cord stimulation (SCS) or conventional medical management (CMM) for chronic pain: a systematic review and meta-analysis.
OBJECTIVE
This study aims to evaluate the efficacy and safety of spinal cord stimulation (SCS) compared to conventional medical management (CMM) for patients diagnosed with chronic pain. Furthermore, the study seeks to compare the utilization of analgesics, as well as the long-term outcomes in terms of quality of life and functional capacity.
DATA SOURCES
We systematically searched Cochrane Library, Web of Science, PubMed, and EMBASE for randomized controlled trials from inception up to February 2022.
REVIEW METHODS
Inclusion and exclusion criteria were set according to the PICOS criteria. We searched for studies in which SCS was compared with CMM alone for chronic pain. Two reviewers independently identified eligible studies and extracted data. Risk of bias assessments were performed according to Cochrane review criteria and Interventional Pain Management Techniques-quality Appraisal of Reliability and Risk of Bias Assessment (IPM-QRB) criteria.
RESULTS
The present meta-analysis comprised eight studies and included a total of 893 patients. Our findings demonstrate that spinal cord stimulation (SCS) in combination with conventional medical management (CMM) is associated with a significant reduction in visual analogue scale (VAS) pain intensity (P = 0.0005) and decreased scores on the McGill Pain Questionnaire (MPQ) (P < 0.0001). Moreover, SCS plus CMM was found to improve patients' quality of life, as evidenced by improvements in SF-36 scores (P < 0.00001), EQ-5D utility index (P = 0.008), and Oswestry Disability Index (ODI) (P < 0.00001). Based on the results of four high-quality randomized controlled trials (RCTs), the level of evidence supporting the efficacy of SCS for the treatment of painful neuropathy is graded as level I to II. In contrast, there is currently only low-level evidence to support the use of high-frequency stimulation and other chronic pain conditions, which can be attributed to a lack of sufficient randomized controlled trials.
LIMITATIONS
The principal limitation of our study is the significant heterogeneity observed among the cohorts investigated. The primary source of this heterogeneity is the fact that spinal cord stimulation is indicated for the treatment of multiple chronic pain conditions. Moreover, variations in the stimulation parameters, differences among manufacturers, and the specific surgical implantation settings contribute to the increased heterogeneity observed in our analyses. To address this issue, we conducted a subgroup analysis based on specific situations and performed evidence synthesis to mitigate the potential impact of heterogeneity. These approaches allow for a more precise interpretation of the results and a more accurate evaluation of the quality of the included studies.
CONCLUSIONS
SCS is an effective treatment to relieve the pain level of chronic pain, decrease analgesic usage, and increase long-term quality of life and functional capacity.
Topics: Humans; Chronic Pain; Spinal Cord Stimulation; Peripheral Nervous System Diseases; Treatment Outcome; Pain Management; Analgesics; Chronic Disease; Spinal Cord
PubMed: 37067600
DOI: 10.1007/s00586-023-07716-2 -
Journal of Neurosurgery. Pediatrics Oct 2018Pediatric spinal astrocytomas are rare spinal lesions that pose unique management challenges. Therapeutic options include gross-total resection (GTR), subtotal resection... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Pediatric spinal astrocytomas are rare spinal lesions that pose unique management challenges. Therapeutic options include gross-total resection (GTR), subtotal resection (STR), and adjuvant chemotherapy or radiation therapy. With no randomized controlled trials, the optimal management approach for children with spinal astrocytomas remains unclear. The aim of this study was to conduct a systematic review and meta-analysis on pediatric spinal astrocytomas.
METHODS
The authors performed a systematic review of the PubMed/MEDLINE electronic database to investigate the impact of histological grade and extent of resection on overall survival among patients with spinal cord astrocytomas. They retained publications in which the majority of reported cases included astrocytoma histology.
RESULTS
Twenty-nine previously published studies met the eligibility criteria, totaling 578 patients with spinal cord astrocytomas. The spinal level of intramedullary spinal cord tumors was predominantly cervical (53.8%), followed by thoracic (40.8%). Overall, resection was more common than biopsy, and GTR was slightly more commonly achieved than STR (39.7% vs 37.0%). The reported rates of GTR and STR rose markedly from 1984 to 2015. Patients with high-grade astrocytomas had markedly worse 5-year overall survival than patients with low-grade tumors. Patients receiving GTR may have better 5-year overall survival than those receiving STR.
CONCLUSIONS
The authors describe trends in the management of pediatric spinal cord astrocytomas and suggest a benefit of GTR over STR for 5-year overall survival.
Topics: Adolescent; Astrocytoma; Child; Child, Preschool; Female; Humans; Male; Neurosurgical Procedures; Spinal Cord Neoplasms; Treatment Outcome
PubMed: 30028275
DOI: 10.3171/2018.4.PEDS17587 -
European Spine Journal : Official... Oct 2021To evaluate the causality between interventions on spinal cord perfusion pressure and neurological outcome in traumatic spinal cord injury. (Review)
Review
PURPOSE
To evaluate the causality between interventions on spinal cord perfusion pressure and neurological outcome in traumatic spinal cord injury.
METHODS
A systematic review was conducted in concordance with PRISMA guidelines. The literature was found in the EMBASE, PUBMED, SCOPUS, and WEB OF SCIENCE. Eligible studies included those that reported measurements and interventions on the spinal cord perfusion pressure in either animals or patients suffering from spinal cord injury. Only studies that reported a clinical or relevant clinical outcome measure (i.e., neurophysiology) were included.
RESULTS
The search yielded 795 unique records, and six studies were included after careful review. These studies suggested a positive correlation between spinal cord perfusion pressure and neurological outcome, but conclusions on causality could not be made.
CONCLUSION
In spite of growing indications that neurological outcomes are related to the spinal cord perfusion pressure in traumatic spinal cord injuries, a solid conclusion cannot be made due to the limited literature available. Additional well-designed studies are needed to address this issue.
Topics: Animals; Humans; Perfusion; Spinal Cord Injuries
PubMed: 34170417
DOI: 10.1007/s00586-021-06905-1 -
Neural Regeneration Research Mar 2024Distraction spinal cord injury is caused by some degree of distraction or longitudinal tension on the spinal cord and commonly occurs in patients who undergo corrective... (Review)
Review
Distraction spinal cord injury is caused by some degree of distraction or longitudinal tension on the spinal cord and commonly occurs in patients who undergo corrective operation for severe spinal deformity. With the increased degree and duration of distraction, spinal cord injuries become more serious in terms of their neurophysiology, histology, and behavior. Very few studies have been published on the specific characteristics of distraction spinal cord injury. In this study, we systematically review 22 related studies involving animal models of distraction spinal cord injury, focusing particularly on the neurophysiological, histological, and behavioral characteristics of this disease. In addition, we summarize the mechanisms underlying primary and secondary injuries caused by distraction spinal cord injury and clarify the effects of different degrees and durations of distraction on the primary injuries associated with spinal cord injury. We provide new concepts for the establishment of a model of distraction spinal cord injury and related basic research, and provide reference guidelines for the clinical diagnosis and treatment of this disease.
PubMed: 37721285
DOI: 10.4103/1673-5374.380871 -
Australian Critical Care : Official... Jan 2020Respiratory complications are the most significant cause of morbidity and mortality in acute cervical spinal cord injury (CSCI). The prevalence of extubation failure... (Meta-Analysis)
Meta-Analysis
PURPOSE
Respiratory complications are the most significant cause of morbidity and mortality in acute cervical spinal cord injury (CSCI). The prevalence of extubation failure (EF) and factors associated with it are unclear. This research aimed to systematically synthesise and pool literature describing EF and associated risk factors in acute CSCI.
METHODS
A systematic review was performed using medical literature analysis and retrieval system online, cummulative index of nursing and allied health literature, excerpta medica dataBASE, and Cochrane library. Articles were screened using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. A proportion meta-analysis was conducted to pool rates of EF. Odds ratios and weighted mean differences were calculated to evaluate risk factors. The R statistical software package was used.
RESULTS
Of the 347 articles that were identified, six articles satisfied the inclusion criteria (387 participants). The pooled EF rate was 20.25% (10.13-36.38%). Type of CSCI was the only statistically significant risk factor. The odds of EF occurring were 2.76 [95% confidence interval (CI): 1.14; 6.70] times greater for complete CSCI than for incomplete CSCI.
CONCLUSIONS
One in five patients with acute cervical SCI fails extubation. The odds of EF occurring are almost three times greater in complete CSCI. Future research should aim to improve standard data sets and prospective evaluation of adjuvant therapy in the peri-extubation period.
Topics: Acute Disease; Airway Extubation; Cervical Cord; Humans; Respiratory Insufficiency; Risk Factors; Spinal Cord Injuries; Treatment Failure
PubMed: 30876697
DOI: 10.1016/j.aucc.2019.01.007 -
Cytotherapy Jan 2024Exosome therapy for traumatic spinal cord injury (TSCI) is a current research hotspot, but its therapeutic effect and the best source of stem cells for exosomes are... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AIMS
Exosome therapy for traumatic spinal cord injury (TSCI) is a current research hotspot, but its therapeutic effect and the best source of stem cells for exosomes are unclear.
METHODS
The Web of Science, PubMed, Embase, Cochrane, and Scopus databases were searched from inception to March 28, 2023. Literature screening, data extraction and risk of bias assessment were performed independently by two investigators.
RESULTS
A total of 40 studies were included for data analysis. The findings of our traditional meta-analysis indicate that exosomes derived from stem cells significantly improve the motor function of TSCI at various time points (1 week: weighted mean difference [WMD] = 1.58, 95% confidence interval [CI] 0.87-2.30] 2 weeks: WMD = 3.12, 95% CI 2.64-3.61; 3 weeks: WMD = 4.44, 95% CI 3.27-5.60; 4 weeks: WMD = 4.54, 95% CI 3.42-5.66). Four kinds of stem cell-derived exosomes have been studied: bone marrow mesenchymal stem cells, adipose mesenchymal stem cells, umbilical cord mesenchymal stem cells and neural stem cells. The results of the network meta-analysis showed that there was no significant statistical difference in the therapeutic effect among the exosomes derived from four kinds of stem cells at different treatment time points. Although exosomes derived from bone marrow mesenchymal stem cells are the current research focus, exosomes derived from neural stem cells have the most therapeutic potential and should become the focus of future attention.
CONCLUSIONS
The exosomes derived from stem cells can significantly improve the motor function of TSCI rats, and the exosomes derived from neural stem cells have the most therapeutic potential. However, the lower evidence quality of animal studies limits the reliability of experimental results, emphasizing the need for more high-quality, direct comparative studies to explore the therapeutic efficacy of exosomes and the best source of stem cells.
Topics: Rats; Animals; Exosomes; Network Meta-Analysis; Reproducibility of Results; Spinal Cord Injuries; Mesenchymal Stem Cells; Spinal Cord
PubMed: 37804282
DOI: 10.1016/j.jcyt.2023.09.002 -
Journal of Craniovertebral Junction &... 2023Multiple Myeloma is a B-cell malignancy which can cause variety of lesions of the spine and spinal cord. The management of patients with spinal cord compression (SCC),... (Review)
Review
BACKGROUND
Multiple Myeloma is a B-cell malignancy which can cause variety of lesions of the spine and spinal cord. The management of patients with spinal cord compression (SCC), and the efficacy and security of minimally invasive therapeutic approaches, are the main topics of discussion.
METHODS
To systematically review the scientific literature on neurosurgical aspects of MM spinal cord lesion management, a search was conducted among scientific papers in the databases ScienceDirect, Cochrane Library, and PubMed using keywords and Boolean operators. These comprise MM and lesions of the spine and spinal cord. Each database was searched from the earliest available article to January 2017.
RESULTS
According to the literature, low-dose radiotherapy, antimyeloma medications, and bisphosphonates comprise the mainstay management for symptomatic spinal lesions. The decision to operation is based on presence of myelopathy and degree of spinal cord compression.
CONCLUSIONS
As a result of the analysis, the following conclusions may be drawn: (1) surgery is a valuable option for MM patients with symptomatic spinal involvement who experience rapid neurological deterioration with SCC and/or mechanical instability and (2) it is important to ensure that the benefits of surgical treatment outweigh the risks, as patients with MM are susceptible to infections.
PubMed: 38268680
DOI: 10.4103/jcvjs.jcvjs_111_23 -
World Neurosurgery Jun 2023Intramedullary spinal cord abscess (ISCA) is an extremely rare disease, which has had fewer than 250 reported cases since its initial description in 1830. The condition... (Review)
Review
BACKGROUND
Intramedullary spinal cord abscess (ISCA) is an extremely rare disease, which has had fewer than 250 reported cases since its initial description in 1830. The condition is limited to level V evidence, limiting the ability for surgeons to characterize and treat it.
OBJECTIVE
To report the cases of 2 patients with ISCA and their surgical management: a 59-year-old woman who presented with progressive right hemiparesis and a 69-old man who presented with acute gait instability and significant bilateral shoulder pain. In addition, to report findings from a systematic literature review and associated logistic regression analysis.
METHODS
A MEDLINE and Embase search was conducted using the keywords "intramedullary," "spinal cord," "abscess," and "tuberculoma" and the results were screened for case reports. A logistic regression model was fit 100 times on data to retrieve predictor odds ratios.
RESULTS
Two hundred case reports of ISCA were identified between 1965 and 2022. Logistic regression determined that the only variables of significance were age (P < 0.01) and antibiotics (P < 0.05).
CONCLUSIONS
Treatment of ISCAs has significantly improved over the years. However, ISCAs are still poorly understood. Our recommendations can be used to guide diagnosis and treatment.
Topics: Male; Female; Humans; Middle Aged; Abscess; Spinal Cord Diseases; Spinal Cord; Anti-Bacterial Agents; Laminectomy; Magnetic Resonance Imaging
PubMed: 36898628
DOI: 10.1016/j.wneu.2023.03.013 -
Journal of Voice : Official Journal of... Jul 2021To analyze and assess studies on the topic and to describe the vocal parameters of patients with traumatic spinal cord injury (SCI) based on the literature. (Review)
Review
OBJECTIVE
To analyze and assess studies on the topic and to describe the vocal parameters of patients with traumatic spinal cord injury (SCI) based on the literature.
METHOD
Studies were identified and selected by searching for articles on the subject published in any journal, using pre-established descriptors: "spinal cord injury," "speech," "lang$," "speech-lang$," and "voice" ("traumatismos da medula espinal," "fala," "fona$," "fonoaud$," and "voz" in Brazilian Portuguese). All the phases of the study were conducted independently by the researchers and in the event of disagreement, a final decision was reached by consensus. The articles selected were critically assessed based on their objectives, treatment, and assessment criteria and methods, results and conclusions, as well their level of scientific evidence.
RESULTS
A total of 70 scientific articles were identified, eight of which were considered valid based on the inclusion criteria. Research on the contribution of speech therapy to patients with SCI is scarce, particularly regarding voice assessment and treatment. Descriptive and observational studies predominated, with a small sample. Data collection was predominated cross-sectional, which made it possible to identify evaluation and intervention techniques, but the methodologies described preclude generalizations. The results indicated that the parameters of the respiratory function and vocal production in patients with traumatic SCI were reduced lung capacity, presence of voice problems, presence of perceived voice problems, and altered activation of accessory respiratory muscle.
CONCLUSION
The vocal parameters of the patients with traumatic SCI can be described, considering the lack of information available. Disorders related to speech therapy vary in accordance with the type and level of injury. It is important to increase scientific production in this area, particularly randomized trials, in order to establish assessment criteria and treatment techniques and improve levels of evidence.
Topics: Cross-Sectional Studies; Humans; Speech; Spinal Cord Injuries; Voice; Voice Disorders
PubMed: 31937482
DOI: 10.1016/j.jvoice.2019.12.013