ABSTRACT
Recent studies in animal models indicate that recombinant human erythropoietin [rhEPO] is very effective in enhancing neurological recovery after spinal cord injury [SCI]. We aimed to evaluate the effect of rhEPO plus methylprednisolone sodium succinate [MPSS] compared to MPSS alone to improve neurological function of patients after SCI in a randomized clinical trial. During a 15-month period 30 patients presenting to emergency departments of two university affiliated hospitals within less than 6 hours after acute SCI were randomized to two groups. Both groups received MPSS 30 mg/kg initially and 5.4 mg/kg every hour till 23 hours if admitted within 3 hours and till 47 hours if recruited within 3-6 hours after injury. Group EPO also received 500unit/kg rhEPO on admission and another 500 unit/kg 24 hours later instead of placebo in group MPSS. Neurologic evaluation was performed on admission, 24, 48, 72 hours and one and 6 months later. Range of patients' age was 18-65 years. There was no significant difference between patients receiving two types of treatment in neurological exam on admission [P=0.125], 24 hours after admission [P=0.108] and 48 hours after admission [P=0.085]. However, one week [P=0.046], one month [P=0.021] and six months [P=0.018] after admission these differences were significant. MPSS plus rhEPO started within 6 hours after acute spinal injury may be more effective than MPSS plus placebo in improvement of neurologic dysfunction. More studies with larger sample sizes are warranted
ABSTRACT
Objective: Aggressive vertebral hemangiomas (VHs) causing spinal compression are rare and there is controversy regarding treatment. This study aims to evaluate clinical results of patients with aggressive VHs after laminectomy, radiotherapy and vertebroplasty with spinal fi xation and to discuss treatment options of tumors. Methods: We performed a retrospective study in 8 patients with aggressive VHs treated with laminectomy, radiotherapy and vertebroplasty with spinal fi xation. In all the patients, tumor was either in thoracic or lumbar spine resulting in myelopathy with extraosseous extension. Tumors were assessed using magnetic resonance imaging (MRI) and the clinical results were evaluated. Results: All of the tumors showed low-intensity or low to isointensity signal on T1-weighted MRI. Laminectomy with or without irradiation was performed in 5 patients. Two patients underwent vertebroplasty with spinal fi xation and conventional radiotherapy was performed in 1 patient. There was no preoperative complication. The myelopathy and patients’ symptoms improved after the surgery. None of the patients had a recurrence at a mean follow-up period of 48 months. Conclusions: A combination of laminectomy, radiotherapy and vertebroplasty with or without spinal fi xation is suggested for the treatment of aggressive VHs with extraosseous extension caused spinal cord compression in all the patients. The clinical results proved satisfactorily in the long-term follow-up.