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Cytotherapy May 2023Several studies have reported that mesenchymal stromal cells (MSCs) may improve neurological functions in patients with spinal cord injury (SCI). In this study, we... (Meta-Analysis)
Meta-Analysis
BACKGROUND AIMS
Several studies have reported that mesenchymal stromal cells (MSCs) may improve neurological functions in patients with spinal cord injury (SCI). In this study, we conducted a systematic review and meta-analysis to summarize the effects of MSC treatment on different degrees of severity of SCI.
METHODS
Systematic searching of studies reporting outcomes of MSCs on specific injury severities of patients with SCI was performed in The National Library of Medicine (MEDLINE), Embase and Cochrane for published articles up to the 6 July 2022. Two investigators independently reviewed the included studies and extracted the relevant data. The standardized mean differences of American Spinal Injury Association (ASIA) motor score, ASIA light touch scores, ASIA pinprick scores and the Barthel index between baseline and follow-ups were pooled.
RESULTS
A total of eight studies were included. A large majority focused on patients with ASIA grade A classification. The pooled mean differences of ASIA motor scores, ASIA light touch scores, ASIA pinprick scores and the Barthel index were -2.78 (95% confidence interval [CI] -5.12 to -0.43, P = 0.02), -18.26 (95% CI -26.09 to -10.43, P < 0.01), -17.08 (95% CI -24.10 to -10.07, P < 0.01) and -4.37 (95% CI -10.96 to 2.22, P = 0.19), respectively.
CONCLUSIONS
MSC transplantation was a significantly effective therapy for patients with SCI with ASIA grade A. In the future, further studies are warranted to confirm the potential beneficial effects of MSC therapy.
Topics: Humans; Spinal Cord Injuries; Mesenchymal Stem Cell Transplantation; Mesenchymal Stem Cells; Spinal Cord
PubMed: 36805381
DOI: 10.1016/j.jcyt.2023.01.012 -
The Journal of Trauma and Acute Care... Aug 2013There is increasing evidence that spinal cord injury without radiologic abnormalities (SCIWORA) is underreported in adults. The increasing availability of magnetic... (Review)
Review
BACKGROUND
There is increasing evidence that spinal cord injury without radiologic abnormalities (SCIWORA) is underreported in adults. The increasing availability of magnetic resonance imaging (MRI) has added substantial information, but there remains considerable disagreement concerning definition as well as diagnostic and therapeutic measures. Furthermore, the interpretability of the literature is constrained by the lack of a reliable classification system based on the morphologic abnormalities visualized by MRI. A comprehensive systematic review was performed to identify all the data published concerning adults experiencing SCIWORA. To assess a potential correlation between clinical and imaging findings, we developed a novel MRI classification system.
METHODS
Database searches were conducted for studies on SCIWORA in adults using PubMed and OvidSP. Inclusion criteria were (1) traumatic spinal cord injury with neurologic deficit, (2) absence of fractures and/or dislocations of the spinal column, and (3) a mature skeleton. Data collected included clinical and radiologic findings. MRI patterns and clinical course were correlated.
RESULTS
Sixty-three articles reporting 1,393 patients were identified, of which 44 studies reported 1,132 cases with MRI imaging. At admission, neurologic deficit assessed by the American Spinal Injury Association impairment scale (AIS) in 567 patients was A in 19.1%, B in 18.5%, C in 39.7%, and D in 22.8%. At final follow-up, these were 6.5%, 4.8%, 20.1%, and 44.3%, respectively. In 7.1%, no MRI abnormalities (Type I) were detected, and 92.9% exhibited abnormal scan results (Type II). Of the latter, 11.7% revealed extraneural (Type IIa), 36.9% revealed intraneural (Type IIb), and 44.3% revealed combined abnormalities (Type IIc). Statistical analysis of neurologic impairment at admission and follow-up revealed significant differences in outcome between patients with different imaging findings.
CONCLUSION
This review emphasizes the prognostic value of spinal MRI for adults with SCIWORA. Using the MRI classification system in future reports will enhance comparability and interpretability and might improve our understanding of the condition.
Topics: Adult; Humans; Magnetic Resonance Imaging; Patient Outcome Assessment; Prognosis; Radiography; Spinal Cord; Spinal Cord Injuries
PubMed: 23702634
DOI: 10.1097/TA.0b013e31829243c9 -
Spinal Cord May 2021Systematic review and meta-analysis. (Meta-Analysis)
Meta-Analysis Review
STUDY DESIGN
Systematic review and meta-analysis.
OBJECTIVES
To identify, critically appraise, and synthesize research findings on non-sensate versus sensate flaps among individuals with spinal cord disease and pelvic pressure ulcers, with pressure ulcer recurrence as primary outcome.
METHODS
PubMed, EMBASE, and Cochrane CENTRAL were screened for relevant studies. Data on surgical characteristics, ulcer recurrence, and sensory outcomes were retrieved and tabulated. Risk of bias was assessed with MINORS. The level of evidence was evaluated with GRADE. Meta-analysis was performed when possible.
RESULTS
Meta-analysis of 1794 non-sensate locoregional reconstructions indicated a recurrence rate of 34% within several years (95% CI, 27-42). Twenty-one articles provided data on 75 sensate reconstructions, performed in 74 individuals. Meta-analysis of the sensate reconstructions indicated a recurrence rate of 1% (95% CI, 0-8). Sensate reconstructions were not associated with an increase of wound complications (19%; 95% CI, 7-40) compared with non-sensate ones (34%; 95% CI, 27-42). A very low level of evidence was determined with use of GRADE.
CONCLUSION
Although of a very low-level, the present evidence suggests that restoration of sensory innervation may be an effective intervention for the prevention of pressure ulcer recurrence among individuals with spinal cord disease. A prospective RCT is needed to confirm or refute the results of this systematic review.
Topics: Humans; Pressure Ulcer; Prospective Studies; Spinal Cord Diseases; Spinal Cord Injuries; Wound Healing
PubMed: 33727678
DOI: 10.1038/s41393-020-00590-5 -
World Neurosurgery Aug 2022Magnetic resonance imaging is considered the most accurate examination to study the spinal cord. Nevertheless, the use of diffusion tensor imaging (DTI) can demonstrate... (Review)
Review
Magnetic resonance imaging is considered the most accurate examination to study the spinal cord. Nevertheless, the use of diffusion tensor imaging (DTI) can demonstrate additional key details about spinal cord lesions. We examined the literature to investigate and discuss the role, limitations, and possible evolution as a prognostic tool of DTI in spinal cord injury (SCI). For this systematic literature review, a detailed search was performed using PubMed (2005-2021), Cochrane Database of Systematic Reviews (2016-2021), and Cochrane Central Register of Controlled Trials (2016-2021). To be included, studies had to report the use of DTI in SCIs, its clinical relevance, and its use as a prognostic tool. We identified 17 studies comprising 299 patients. The mean age of patients was 41.22 ± 10.62 years. There was a prevalence of males (70.9%) compared with females (29.1%). The main spinal cord tract involved and studied in SCIs was the cervical tract (57.5%), followed by conus terminalis (15.4%) and dorsal tract (13.7%). In all studies based on American Spine Injury Association impairment scale score for neurological assessment, a correlation was found between FA values and American Spine Injury Association impairment scale: patients with complete SCI had a statistically significative lower FA value at the injured site compared with patients with incomplete SCI. Published clinical studies showed promising results for the utility of DTI parameters as noninvasive biomarkers in SCI grade evaluation, remaining an evolving area of further investigation.
Topics: Adult; Female; Humans; Male; Middle Aged; Diffusion Tensor Imaging; Prognosis; Spinal Cord; Spinal Cord Injuries
PubMed: 35500874
DOI: 10.1016/j.wneu.2022.04.103 -
NeuroImage. Clinical 2016A recent meeting of international imaging experts sponsored by the International Spinal Research Trust (ISRT) and the Wings for Life Foundation identified 5... (Review)
Review
BACKGROUND
A recent meeting of international imaging experts sponsored by the International Spinal Research Trust (ISRT) and the Wings for Life Foundation identified 5 state-of-the-art MRI techniques with potential to transform the field of spinal cord imaging by elucidating elements of the microstructure and function: diffusion tensor imaging (DTI), magnetization transfer (MT), myelin water fraction (MWF), MR spectroscopy (MRS), and functional MRI (fMRI). However, the progress toward clinical translation of these techniques has not been established.
METHODS
A systematic review of the English literature was conducted using MEDLINE, MEDLINE-in-Progress, Embase, and Cochrane databases to identify all human studies that investigated utility, in terms of diagnosis, correlation with disability, and prediction of outcomes, of these promising techniques in pathologies affecting the spinal cord. Data regarding study design, subject characteristics, MRI methods, clinical measures of impairment, and analysis techniques were extracted and tabulated to identify trends and commonalities. The studies were assessed for risk of bias, and the overall quality of evidence was assessed for each specific finding using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.
RESULTS
A total of 6597 unique citations were identified in the database search, and after full-text review of 274 articles, a total of 104 relevant studies were identified for final inclusion (97% from the initial database search). Among these, 69 studies utilized DTI and 25 used MT, with both techniques showing an increased number of publications in recent years. The review also identified 1 MWF study, 11 MRS studies, and 8 fMRI studies. Most of the studies were exploratory in nature, lacking a priori hypotheses and showing a high (72%) or moderately high (20%) risk of bias, due to issues with study design, acquisition techniques, and analysis methods. The acquisitions for each technique varied widely across studies, rendering direct comparisons of metrics invalid. The DTI metric fractional anisotropy (FA) had the strongest evidence of utility, with moderate quality evidence for its use as a biomarker showing correlation with disability in several clinical pathologies, and a low level of evidence that it identifies tissue injury (in terms of group differences) compared with healthy controls. However, insufficient evidence exists to determine its utility as a sensitive and specific diagnostic test or as a tool to predict clinical outcomes. Very low quality evidence suggests that other metrics also show group differences compared with controls, including DTI metrics mean diffusivity (MD) and radial diffusivity (RD), the diffusional kurtosis imaging (DKI) metric mean kurtosis (MK), MT metrics MT ratio (MTR) and MT cerebrospinal fluid ratio (MTCSF), and the MRS metric of N-acetylaspartate (NAA) concentration, although these results were somewhat inconsistent.
CONCLUSIONS
State-of-the-art spinal cord MRI techniques are emerging with great potential to improve the diagnosis and management of various spinal pathologies, but the current body of evidence has only showed limited clinical utility to date. Among these imaging tools DTI is the most mature, but further work is necessary to standardize and validate its use before it will be adopted in the clinical realm. Large, well-designed studies with a priori hypotheses, standardized acquisition methods, detailed clinical data collection, and robust automated analysis techniques are needed to fully demonstrate the potential of these rapidly evolving techniques.
Topics: Animals; Brain Mapping; Diffusion Tensor Imaging; Humans; Magnetic Phenomena; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Myelin Sheath; Spinal Cord; Spinal Cord Injuries; Translational Research, Biomedical; Water
PubMed: 26862478
DOI: 10.1016/j.nicl.2015.11.019 -
The Journal of Spinal Cord Medicine Jul 2023Spinal cord injury (SCI) is associated with several gastrointestinal disorders, and the prevalence of cholelithiasis is high in this population. Because individuals with...
CONTEXT
Spinal cord injury (SCI) is associated with several gastrointestinal disorders, and the prevalence of cholelithiasis is high in this population. Because individuals with SCI may have atypical symptoms and more advanced disease, some treatment centers advocate prophylactic cholecystectomy for patients with SCI and gallstone disease.
OBJECTIVE
To systematically review the existence and quality of studies on prophylactic cholecystectomy in individuals with SCI and cholelithiasis.
METHODS
A systematic search of literature up to July 10, 2022 was conducted in accordance with PRISMA guidelines using the Medline, Cochrane, and Web of Science databases. Keywords used were "cholecystectomy," "gallbladder," "cholelithiasis," "gallstone," and "spinal cord injury."
RESULTS
The search identified 118 articles, of which 4 met the inclusion criteria. All these were retrospective observational studies. Prophylactic cholecystectomy was performed in 4-16.5% of the participants. The causes of cholecystectomy were chronic cholecystitis with biliary colic (44.5-63.5%), acute cholecystitis (4-26%), choledocholithiasis (6-11%) and pancreatitis (2-6%). Operative times, conversion rates, estimated blood loss, severity of complications, morbidity and mortality did not differ significantly between individuals with SCI and neurologically able individuals.
CONCLUSION
No prospective cohort studies comparing prophylactic cholecystectomy with conservative management in individuals with SCI and gallstone disease have been conducted. Therefore, there is no robust evidence to support prophylactic cholecystectomy and further studies are required.
Topics: Humans; Spinal Cord Injuries; Retrospective Studies; Cholecystectomy; Cholelithiasis
PubMed: 36355833
DOI: 10.1080/10790268.2022.2144026 -
Neurochemistry International Dec 2023Parvalbumin is one of the calcium-binding proteins. In the spinal cord, it is mainly expressed in inhibitory neurons; in the dorsal root ganglia, it is expressed in... (Review)
Review
Parvalbumin is one of the calcium-binding proteins. In the spinal cord, it is mainly expressed in inhibitory neurons; in the dorsal root ganglia, it is expressed in proprioceptive neurons. In contrast to in the brain, weak systematization of parvalbumin-expressing neurons occurs in the spinal cord. The aim of this paper is to provide a systematic review of parvalbumin-expressing neuronal populations throughout the spinal cord and the dorsal root ganglia of mammals, regarding their mapping, co-expression with some functional markers. The data reviewed are mostly concerning rodentia species because they are predominantly presented in literature.
Topics: Animals; Calcium-Binding Proteins; Parvalbumins; Ganglia, Spinal; Spinal Cord; Neurons; Mammals
PubMed: 37967669
DOI: 10.1016/j.neuint.2023.105634 -
Human Reproduction Update 2013BACKGROUND After spinal cord injury (SCI), most men cannot ejaculate without medical assistance. A major advance in the knowledge of the spinal control of ejaculation... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND After spinal cord injury (SCI), most men cannot ejaculate without medical assistance. A major advance in the knowledge of the spinal control of ejaculation has been achieved with the discovery of a spinal generator of ejaculation (SGE) in the rat. The aim of this report was to review studies about ejaculation after SCI in order to revisit the spinal control of ejaculation and especially to assess the existence of an SGE in man. METHODS Studies were identified from Embase, PubMed, EBSCOhost and Cochrane Library. Studies were eligible when they specify the occurrence of antegrade ejaculation as a function of the neurological characterization of SCI. Studies were excluded when ejaculation was elicited by rectal electrical stimulation or when ejaculation could not be discriminated from climax. Meta-analyses were performed to assess the reference ejaculation rates for each procedure used to elicit ejaculation, i.e. masturbation or coïtus, penile vibratory stimulation (PVS) or acetylcholine esterase (AchE) inhibitors prior to masturbation. Subgroup analyses were performed according to the procedure used to elicit ejaculation on (i) the completeness of the SCI and (ii) the upper and lower limits of the SCI. To assess the existence of an SGE, the effect of concurrent lesions of different spinal segments was assessed by means of a stratified bivariate analysis. RESULTS From 523 studies, 45 were selected (n = 3851). Ejaculation occurred in response to masturbation or coïtus, PVS or AchE inhibitors followed by masturbation in, respectively, 11.8% (n = 1161), 47.4% (n = 597) and 54.7% (n = 309) of patients with complete SCI and in, respectively, 33.2% (n = 343), 52.8% (n = 305) and 78.1% (n = 32) of patients with incomplete SCI. Ejaculation, in the case of complete lesion of the sympathetic centres (T12 to L2), of the parasympathetic and somatic centres (S2-S4) or of all spinal ejaculation centres (T12 to S5) occurred in response to PVS in none of the patients (respectively, n = 5, n = 4 and n = 21) and in response to AchE inhibitors followed by masturbation in 4.9% (n = 61), 30.8% (n = 26) and 0% (n = 16) of the patients, respectively. Ejaculation in response to PVS or AchE inhibitors prior to masturbation was rhythmic forceful in 97.9% (n = 48) of the patients with complete lesion strictly above Onuf's nucleus (segments S2-S4). Complete lesion of the S2-S4 segments precluded the occurrence of rhythmic forceful ejaculation (n = 5). Controlling for the number of the injured segments between T12 and L2, the ejaculation rate sharply decreased when the lesion extended to the L3 segment and below. CONCLUSIONS The results reinforce the crucial roles of the spinal sympathetic and parasympathetic centres for emission and the somatic centre for expulsion. The spinal segments between L2 and S2 is more than a pathway to connect the ejaculation centres and likely harbours an SGE in man located in the L3, L4 and L5 segments.
Topics: Animals; Coitus; Ejaculation; Humans; Male; Rats; Sexual Dysfunction, Physiological; Spinal Cord; Spinal Cord Injuries
PubMed: 23820516
DOI: 10.1093/humupd/dmt029 -
The Journal of Spinal Cord Medicine Jul 2021Need for evidential support of practice guideline recommendations for management of neurogenic bowel management in adults with spinal cord injury. To determine evidence...
Digital rectal stimulation as an intervention in persons with spinal cord injury and upper motor neuron neurogenic bowel. An evidenced-based systematic review of the literature.
Need for evidential support of practice guideline recommendations for management of neurogenic bowel management in adults with spinal cord injury. To determine evidence for digital rectal stimulation (DRS) as an intervention in the management of upper motor neuron neurogenic bowels (UMN-NB) in persons with spinal cord injury (SCI). A systematic review of the literature including research articles and practice guidelines evaluating upper motor neuron neurogenic bowel treatments and the use of digital rectal stimulation was performed using OvidMedline, PubMed and the Cochrane database and included research articles and practice guidelines. Limitations were made related to English language, patient age and focus on spinal cord injured patients. Strength of evidence was assessed using the Johns Hopkins Nursing evidence-based practice model. Eleven articles were included in the systematic review. Only one used DRS as a primary intervention. There was moderate evidence for DRS in persons with SCI and UMN-NB. There was evidence of the physiologic effect of DRS and support for combining DRS with other treatment regimens. There is insufficient evidence to promote any one intervention for the management of UMN-NB. The promotion of DRS, and education as to the proper technique for DRS should remain an emphasis of education of home management of UMN-NB in persons with SCI. Future research should focus on the use of standardized, validated tools to evaluate management techniques for UMN-NB.
Topics: Adult; Humans; Motor Neurons; Neurogenic Bowel; Rectum; Spinal Cord Injuries
PubMed: 31809250
DOI: 10.1080/10790268.2019.1696077 -
Reviews in the Neurosciences Dec 2023In recent decade microglia have been found to have a central role in the development of chronic neuropathic pain after injury to the peripheral nervous system. It is... (Review)
Review
In recent decade microglia have been found to have a central role in the development of chronic neuropathic pain after injury to the peripheral nervous system. It is widely accepted that peripheral nerve injury triggers microglial activation in the spinal cord, which contributes to heightened pain sensation and eventually chronic pain states. The contribution of microglia to chronic pain arising after injury to the central nervous system, such as spinal cord injury (SCI), has been less studied, but there is evidence supporting microglial contribution to central neuropathic pain. In this systematic review, we focused on post-SCI microglial activation and how it is linked to emergence and maintenance of chronic neuropathic pain arising after SCI. We found that the number of studies using animal SCI models addressing microglial activity is still small, compared with the ones using peripheral nerve injury models. We have collected 20 studies for full inclusion in this review. Many mechanisms and cellular interactions are yet to be fully understood, although several studies report an increase of density and activity of microglia in the spinal cord, both in the vicinity of the injury and in the spared spinal tissue, as well as in the brain. Changes in microglial activity come with several molecular changes, including expression of receptors and activation of signalling pathways. As with peripheral neuropathic pain, microglia seem to be important players and might become a therapeutic target in the future.
Topics: Animals; Humans; Microglia; Peripheral Nerve Injuries; Chronic Pain; Neuralgia; Spinal Cord Injuries
PubMed: 37490300
DOI: 10.1515/revneuro-2023-0031