Case report: combination therapy with mesenchymal stem cells and granulocyte-colony stimulating factor in a case of spinal cord injury

Introduction: Various neuroregenerative procedures have been recently employed along with neurorehabilitation programs to promote neurological function after Spinal Cord Injury [SCI], and recently most of them have focused on the acute stage of spinal cord injury. In this report, we present a case of acute SCI treated with neuroprotective treatments in conjunction with conventional rehabilitation program

Methods: A case of acute penetrative SCI [gunshot wound], 40 years old, was treated with intrathecal bone marrow derived stem cells and parenteral Granulocyte-Colony Stimulating Factor [G-CSF] along with rehabilitation program. The neurological outcomes as well as safety issues have been reported

Results: Assessment with American Spinal Injury Association [ASIA], showed neurological improvement, meanwhile he reported neuropathic pain, which was amenable to oral medication

Discussion: In the acute setting, combination therapy of G-CSF and intrathecal Mesenchymal Stem Cells [MSCs] was safe in our case as an adjunct to conventional rehabilitation programs. Further controlled studies are needed to find possible side effects, and establish net efficacy

Lumbosacral Sagittal Alignment in Association to Intervertebral Disc Diseases

STUDY DESIGN: A cross-sectional case-control study was designed to compare the sagittal alignment of lumbosacral regions in two groups of patients suffering from low back pain, one with intervertebral disc pathologies and one without. PURPOSE: To evaluate the correlation between lumbosacral sagittal alignment and disc degeneration. OVERVIEW OF LITERATURE: Changes in lumbar lordosis and pelvic parameters in degenerative disc lesions have been assessed in few studies. Overall, patients with discopathy were shown to have lower lumbar lordosis and more vertical sacral profiles. METHODS: From patients with intractable low back pain undergoing lumbosacral magnetic resonance imaging, 50 subjects with disc degeneration and 50 controls with normal scans were consecutively enrolled. A method was defined with anterior tangent-lines going through anterior bodies of L1 and S1 to measure global lumbosacral angle, incorporating both lumbar lordosis and sacral slope. Global lumbosacral angle using the proposed method and lumbar lordosis using Cobb's method were measured in both groups. RESULTS: Lumbar lordosis based on Cobb's method was lower in group with discopathy (20degrees-67degrees; mean, 40.48degrees+/-9.89degrees) than control group (30degrees-62degrees; mean, 44.96degrees+/-7.68degrees), although it was not statistically significant. The proposed global lumbosacral angle in subject group (53degrees-103degrees; mean, 76.5degrees+/-11.018degrees) was less than control group (52degrees-101degrees; mean, 80.18degrees+/-9.95degrees), with the difference being statistically significant (p=0.002). CONCLUSIONS: Patients with intervertebral disc lesions seem to have more straightened lumbosacral profiles, but it has not been proven which comes first: disc degeneration or changes in sagittal alignment. Finding an answer to this dilemma demands more comprehensive long-term prospective studies.

Preoperative CT and intra-operative physical space registration of the spine using an articulated model: a phantom study

Due to the difference in spine curvature in intra-operative and preoperative situations in image guided spine surgery [IGSS], each vertebra needs to be registered separately. This can be done by collecting anatomical landmarks on the patient's anatomy using a pointer and a tracker, and registering them with corresponding points on the 3D model of CT images. Registering each vertebra using this method can be a tedious and time consuming task. Registering the spine using an articulated model, which incorporates the inter-vertebral transformation between consecutive vertebra, introduces a simple and efficient framework. In this paper, a deformation [extension] is applied to the lumbar vertebra of a spine phantom. Local coordinate systems are defined separately for each vertebra in the 3D model reconstructed from CT images before deformation and on the phantom after deformation. The intervertebral transformations for consecutive vertebrae are calculated in the 3D models. Registration is carried out using the local coordinate systems and the intervertebral transformations. This method was evaluated using point based registration with known corresponding points in both spaces. These results were also compared to those of surface based registration. As indicated by the results, an average improvement of 30% in the registration accuracy was achieved compared to the surface based registration method with acquired random points. The proposed method decreases the registration time by eliminating the need to acquire surface points on each individual vertebra. It is also applicable in situations with defected vertebrae where anatomical landmarks are difficult to distinguish

Safety of intramedullary autologous peripheral nerve grafts for post-rehabilitated complete motor spinal cord injuries: a phase I study

Many experimental studies have reported behavioral improvement after transplantation of peripheral nerve tissue into the contused spinal cord, even in large animals. The safety of this treatment in human remains unknown. In this translational phase 1 study, safety of peripheral nerve grafting for chronic spinal cord injuries and possible outcomes are being reported. Twelve complete motor spinal cord injury patients, who had finished their rehabilitation program, were enrolled. There were 4 thoracic and 8 cervical cases. Patients underwent sural nerve preconditioning in the calf, followed 1week later, by intramedullary transplantation of the harvested nerve fascicles. The patients were followed up for potential complications periodically, and final assessment by American Spinal Injury association [ASIA] and Spinal Cord Independence Measure [SCIM] III were reported after 2 years of follow-up. The median duration of the spinal cord injury was 31 months. At two years of follow up, out of 7 cases with ASIA Impairment Scale [AIS] A, 4 [57.1%] cases improved to AIS B and 1 [14.3%] case became AIS C. There were 1 patient with transient increased spasm, one case of transient cystitis, 3 patients with transient increased neuropathic pain and 1 case with transient episode of autonomic dysreflexia, all being managed medically. There was no case of donor site infection. The above complications were transient as they responded to temporary medical treatment. It may be deduced that after two years follow-up of patients that the procedure may be safe, however further controlled studies are needed to prove its efficacy

Diagnostic accuracy of early computed tomographic angiography for visualizing medium sized inferior and posterior projecting carotid system aneurysms

Conventional angiography, generally referred to as intra-arterial digital subtraction angiography, still remains the gold standard reference method for the diagnosis of intracranial aneurysms, helical computed tomography angiography [CTA] is a new non-invasive volumetric imaging method. This study was conducted to screen patients presenting with subarachnoid-hemorrhage by CTA before conventional digital subtraction angiography [DSA] and subsequently comparing the results for various aneurysm projections. In a prospective study, 99 consecutive patients with an initial diagnosis of subarachnoid hemorrhage were screened for aneurysms with CTA followed by conventional DSA. There were 17 cases with negative angiograms in whom repeat angiograms, three months later were negative for 15 cases, while two cases were found to bear aneurysm on the repeat examination. Eighty two patients had at least one proven aneurysm on initial DSA and two on the repeat angiogram. Out of 84 patients, five underwent endovascular treatment and 79 patients who underwent surgical clipping were considered for projection evaluation. Sensitivity of CTA was 98.78% [95% confidence interval [CI], 93.4-99.7%], while the specificity was 100% [95% CI, 81.57-100%] and the kappa coefficient of agreement between CTA and DSA was 96.5%. The most significant discrepancies with DSA findings were for visualizing the projection of inferior and posterior projecting proximal anterior circulation aneurysms. Helical CTA was in good concordance with DSA for screening of cerebral aneurysms; however, for exact visualization of the aneurysm neck and its projection, especially if it is inferior or posterior, DSA remains the gold standard

Cortical representation of Persian word production: an fMRI study

Neural correlates of single word reading with the use of a functional MRI [fMRI] scan have been widely studied in different languages. These study patterns of cortical activation differ in different languages. In this report we used a similar technique to study cortical activation when reading single Persian words. The subjects were comprised of nine healthy right-handed bilingual individuals who performed three consecutive fMRI paradigms. Our study showed activation of the inferior frontal gyrus [IFG] when single Persian words were read. These results revealed that the pattern of brain activation during word production in Persian has a similar topography to that of English equivalents. The paradigms selectively activate word production areas and are useful in neurological assessment of the Persian population

Olfactory groove schwannoma masquerading as an orbital mass

Olfactory groove schwannoma is a very rare tumor breaking through the skull base and orbit. The tumor may also extend to the subfrontal region intradurally. A case of olfactory groove schwannoma in a 35-year-old female, originating from the left olfactory groove with left proptosis, diplopia, supra-orbital mass, and gross intracranial extension is reported. The presence of bony scalloping on CT and absence of meningeal tail on contrast enhanced MRI are in favor of the diagnosis. Histological examination and immuno-histochemical evaluation for S-100 protein, showed the tumor as a schwannoma. Total excision through a frontal craniotomy and skull base reconstruction are the main therapeutic steps