Radionuclide shunt patency study for suspected ventriculoatrial shunt malfunction.

OBJECTIVE: Radionuclide shunt studies have been used for decades to evaluate intracranial shunt patency (SP); however, the methodology is neither standardized nor well validated. The purpose of this study was to determine the clinical utility of radionuclide ventriculoatrial (VA) SP study for diagnosis of suspected shunt malfunction. METHODS: A retrospective review was undertaken of all patients who had a VA radionuclide SP study between 2001 and 2009. All had a 20-minute gamma camera acquisition (1 min/frame) immediately following injection of 99mTc DTPA into the shunt reservoir. Time-activity curves were generated and a half-time (T½) of emptying quantified. The results were correlated with the final clinical diagnoses. RESULTS: Forty-nine studies in 40 adult patients with a minimum of 6 months' follow-up were analyzed. Thirteen shunt studies had a T½ of 3.9 to 8.0 minutes, had final diagnosis of normal functioning shunt, and did not need revision surgery for a mean follow-up of 15.1 months. Fourteen patient studies had a T½ of less than 3.9 minutes; 13 had final diagnosis of overdraining shunts, and 1 required revision surgery. Twenty-two had a T½ longer than 8 minutes: 13 had final diagnosis of shunt obstruction, 4 had overdrainage, and 5 had underdrainage. CONCLUSIONS: The radionuclide SP study is valuable for evaluation of VA SP. Results can be interpreted using a single variable (T½). T½ of 3.9 to 8 minutes indicates a patent shunt; T½ less than 3.9 minutes is consistent with overdrainage. T½ of >8 requires further evaluation to differentiate between obstruction and overdrainage/underdrainage.

Vascular access graft and native arterial branch fistulous formation.

This is the first reported case of an unusual complication of upper extremity swelling of the arm in a patient with an arteriovenous (AV) graft for haemodialysis. A graftogram demonstrated an aberrant fistula formation between the native arterial branch and the AV graft (aberrant arterio-graft fistula). Inadvertent back wall laceration of the AV graft during haemodialysis cannulation was postulated to be the aetiology. Aberrant arterio-graft fistula formation may be hard to diagnose because of the presence of thrill or bruit at the level of the anastomoses and rarity of the complication. Progression of extremity swelling with or without central venous occlusion should raise the suspicion and sought further investigation. Proper cannulation techniques prior to haemodialysis may prevent such complications.

An in vivo evaluation of cerebral cortical amyloid with [18F]flutemetamol using positron emission tomography compared with parietal biopsy samples in living normal pressure hydrocephalus patients.

PURPOSE: The primary objectives of this study were to assess the safety of [(18)F]flutemetamol injection and determine the level of association between the quantitative estimates of brain uptake of [(18)F]flutemetamol and the quantitative immunohistochemical (IHC) estimates of amyloid levels in cerebral cortex biopsies obtained during shunt placement in patients with normal pressure hydrocephalus (NPH). PROCEDURES: Parietal lobe biopsies were obtained from 12 subjects (mean (SD), 71 (8.1) years), during shunt placement for NPH. Shunt procedures and biopsies were performed within 8 weeks after the positron emission tomography (PET) imaging, and followed by a computed tomography scan. The quantitative estimates of the brain uptake of [(18)F]flutemetamol (standard uptake value ratios (SUVRs)) from the biopsy site, contralateral to the biopsy site, and composite were made from the analysis of PET images. The quantitative IHC levels of amyloid load were estimated using a monoclonal antiamyloid ß antibody, 4 G8 (in percent area), as the standard of truth (N = 8, of which 5 had full histopathology staining). The primary analysis determined the level of association between the SUVR (with cerebellum as the reference region) from the biopsy site, and the level of amyloid was determined from IHC estimates of amyloid in the biopsy sample. RESULTS: [(18)F]Flutemetamol injection was found to be well tolerated. The biopsied area well represented the amyloid deposition throughout the cortex in this small sample. The biopsy site SUVR was significantly correlated with the biopsy specimen amyloid ß level (expressed as percent of biopsy specimen area staining with 4 G8). The full model was significant (p = 0.0174). In the secondary efficacy analyses, contralateral (to biopsy site) and composite SUVR values correlated significantly with the percent of biopsy specimen staining for amyloid ß based on 4 G8. Blinded visual [(18)F]flutemetamol image interpretations showed a sensitivity of 100 % and a specificity of 100 % with pathology reads staining for amyloid plaque with Bielschowsky and thioflavin S and overall pathology read. The results of the blinded reader agreement for [(18)F]flutemetamol PET showed full agreement among three readers. CONCLUSIONS: PET imaging of NPH patients following the administration of [(18)F]flutemetamol injection was highly correlated with the presence of fibrillar amyloid ß in subsequent cortical biopsy samples in this small sample. Administration of [(18)F]flutemetamol injection was well tolerated.

The evaluation of FDG-PET imaging for epileptogenic focus localization in patients with MRI positive and MRI negative temporal lobe epilepsy.

INTRODUCTION: We studied the contribution of interictal FDG-PET ([18 F] fluorodeoxyglucose-positron emission tomography) in epileptic focus identification in temporal lobe epilepsy patients with positive, equivocal and negative magnetic resonance imaging (MRI). METHODS: Ninety-eight patients who underwent surgical treatment for drug resistant temporal lobe epilepsy after neuropsychological evaluation, scalp video EEG monitoring, FDG-PET, MRI and/or long-term intracranial EEG and with >12 months clinical follow-up were included in this study. FDG-PET findings were compared to MRI, histopathology, scalp video EEG and long-term intracranial EEG monitoring. RESULTS: FDG-PET lateralized the seizure focus in 95 % of MRI positive, 69 % of MRI equivocal and 84 % of MRI negative patients. There was no statistically significant difference between the surgical outcomes among the groups with Engel class I and II outcomes achieved in 86 %, 86 %, 84 % of MRI positive, equivocal and negative temporal lobe epilepsy patients, respectively. The patients with positive unilateral FDG-PET demonstrated excellent postsurgical outcomes, with 96 % Engel class I and II. Histopathology revealed focal lesions in 75 % of MRI equivocal, 84 % of MRI positive, and 23 % of MRI negative temporal lobe epilepsy cases. CONCLUSION: FDG-PET is an accurate noninvasive method in lateralizing the epileptogenic focus in temporal lobe epilepsy, especially in patients with normal or equivocal MRIs, or non-lateralized EEG monitoring. Very subtle findings in MRI are often associated with histopathological lesions and should be described in MRI reports. The patients with negative or equivocal MRI temporal lobe epilepsy are good surgical candidates with comparable postsurgical outcomes to patients with MRI positive temporal lobe epilepsy.

Ultrastructural changes in the liver after experimental spinal cord injury in rats: effects of methylprednisolone, immunoglobulin g and albumin.

AIM: Spinal Cord Injury (SCI) is routinely treated with standardized methyl prednisolone sodium succinate (MPSS) dose, so it is reassuring to find its effects on liver. We also evaluated the effects of albumin and immunoglobulin G (Ig G) therapies on liver if they are used in case of experimental SCI. MATERIAL AND METHODS: The rats were allocated into six groups as control, trauma, vehicle, MPSS, Ig G and albumin consisting 8 rats for each. The rats with SCI were assigned to 30mg/kg MPSS, 5 mg/kg albumin and 400 mg/kg Ig G treatments. Tissue samples from liver were obtained for light and electron microscopy examinations and determination of myeloperoxidase (MPO) activity. RESULTS: Trauma increased MPO activity and caused cellular changes of liver tissue. Both albumin and Ig G treatments decreased MPO activity significantly. The light and electron microscopic evaluations showed remarkable preservation of liver ultra-structure with all treatments including MPSS. CONCLUSIONS: SCI resulted in neutrophil infiltration and changes in ultrastructure of liver. It was revealed that MPSS has no detrimental effects on liver. Although all treatments preserved liver tissue structure, Although all treatments preserved liver tissue structure, Ig G and albumin treatments also prevented neutrophil infiltration. To provide protection from secondary liver injury after SCI, use of albumin and Ig G treatments may be beneficial.

Transthoracic surgical treatment for centrally located thoracic disc herniations presenting with myelopathy: a 5-year institutional experience.

STUDY DESIGN: Retrospective review. OBJECTIVE: Review clinical outcomes for myelopathic patients undergoing transthoracic discectomies for central calcified herniations. SUMMARY OF BACKGROUND DATA: Ideal surgical treatment for thoracic disc herniation is controversial due to variations in patient presentation, pathology, and possible surgical approach. Although discectomy may lead to improvements in neurologic function, it can be complicated by approach-related morbidity, especially for ventral calcified disc herniations. Review of clinical outcomes for myelopathic patients undergoing transthoracic discectomies for central calcified herniations was completed, paying special attention to neurologic status and procedure-related complications. METHODS: Between 2002 and 2007, 27 myelopathic patients were treated with 28 transthoracic surgeries for centrally located symptomatic calcified thoracic disc herniations over the last 5 years at a single institution. Demographic data, details of surgery, preoperative and postoperative Nurick and American Spinal Injury Association scores, length of stay, complications, and follow-up data were collected in all patients. RESULTS: A total of 27 patients, 8 male (30%) and 19 female (70%) with an average age of 52.3 years (range: 19 to 72) underwent 28 thoracotomies. All had myelopathy whereas 6/27 also had radicular pain syndromes. Fourteen patients had anterior instrumentation alone, 3 had anterior and posterior instrumentation, and 1 had posterior instrumentation alone. Average Nurick grade was 2.5 preoperatively and 1.4 postoperatively. Of note, American Spinal Injury Association scores improved postoperatively in 12/27 patients (10D to 10E; 2C to 2D), remained unchanged in 13/27 (11E to 11E, 2D to 2D), and worsened in 2/27 (2D to 2C). Average length of stay was 7 days (range: 3 to 15). All patients required chest tube placement with average duration of 4 days (range: 1 to 7). Major complications occurred in 6 cases (21.4%) over an average follow-up of 12 months (range: 1 to 40 mo). CONCLUSIONS: Thoracotomy for treatment of centrally located thoracic disc herniations is associated with improvement in or stabilization of myelopathic symptoms in the majority of patients with an acceptable rate of complications. Interestingly, most patients with weakness improved in strength (12/16, 75%), no patients with normal strength developed new weakness (10/10, 100%), and only 2 patients had new weakness noted postoperatively (7.4%).

Adjuvant treatment with locally delivered OncoGel delays the onset of paresis after surgical resection of experimental spinal column metastasis.

OBJECTIVE: The optimal management of spinal column metastatic disease is controversial. Local chemotherapy delivery systems allow targeted high-dose adjuvant therapy. We evaluated whether injection of OncoGel paclitaxel-releasing biodegradable polymer (Protherics, Inc., West Valley City, UT) into the tumor resection cavity at the time of surgery would improve the efficacy of surgical resection with or without external beam radiotherapy (XRT) in a rat model of spinal column metastases. METHODS: Fischer-344 rats (Charles River Laboratories, Wilmington, MA) underwent a transabdominal approach for implantation of a CRL-1666 breast adenocarcinoma cell line within the L6 vertebral body. In experiment 1, 7 days after tumor implantation, animals underwent 1 of 2 treatments or no treatment (n = 8 per group): control (no treatment); surgery alone (L6 corpectomy); or surgery + OncoGel (L6 corpectomy with OncoGel implantation into the resection cavity). In experiment 2, 7 days after tumor implantation, animals underwent 1 of 2 treatments or no treatment (n = 8 per group): control (no treatment); surgery + XRT (L6 corpectomy followed by XRT [total 20 Gy]); or surgery + XRT + OncoGel (L6 corpectomy with OncoGel implantation followed by XRT). In experiment 3, 7 days after tumor implantation, animals underwent 1 of 2 treatments or no treatment (n = 8 per group): control (no treatment); XRT alone (total 20 Gy); or XRT + OncoGel. Daily hindlimb function was assessed using the Basso, Beattie, and Bresnahan (BBB) scale (range, 1-21). RESULTS: In experiment 1, both treatment groups had delayed onset of paresis compared with control. Compared with surgery alone, surgery + OncoGel resulted in superior median BBB scores on posttreatment days 9 (21 versus 19, P < 0.001) through 14 (11 versus 8, P < 0.005). In experiment 2, both treatment groups had delayed onset of paresis compared with control. Compared with surgery + XRT, surgery + XRT + OncoGel resulted in superior median BBB scores on posttreatment days 13 (21 versus 19, P < 0.001) through 17 (12 versus 8, P < 0.005). Median time to loss of ambulation (BBB scale score

Immunomodulation of acute experimental spinal cord injury with human immunoglobulin G.

Immunomodulation of acute spinal cord injury may inhibit the activity of specific inflammatory cascades and result in recovery of motor function. In this study, evaluation of the protective effect of a well-known anti-inflammatory immunomodulator, immunoglobulin G (IgG), was conducted in rats after a 50 g/cm contusion spinal cord injury. Following injury, 400 mg/kg of IgG was administered to the treatment group. Twenty-four hours later, animals were assessed functionally via an inclined plane and the Basso-Beattie-Bresnahan motor scale and compared to controls. Tissue was reviewed for myeloperoxidase activiy (MPO) and lipid peroxidation (LPO), and electron microscopy was conducted to assess tissue ultrastructure. Significant functional preservation was observed in the IgG treatment group. In addition, biochemical assays revealed decreased MPO activity, and electron microscopic views of tissue showed preserved ultrastructure. IgG treatment following acute contusion injury to the rat spinal cord confers functional and structural neuroprotection.

Surgical management of cervical spondylotic myelopathy with laminectomy and instrumented fusion.

OBJECTIVE: The indications for treating cervical spondylotic myelopathy (CSM) with laminectomy and instrumented fusion remain ill-defined. Cervical laminectomy without instrumented fusion has been associated with suboptimal outcomes, particularly in the setting of cervical kyphosis. This work's purpose is to retrospectively review our experience in patients who underwent laminectomy with instrumented fusion for CSM and to assess the neurological and radiological outcomes of patients treated with this technique. METHODS: Fifty-four consecutive patients underwent multilevel laminectomy and instrumented fusion for CSM. The indications were patients with (1) cervical stenosis > or = 3 spinal segments and (2) absence of a cervical kyphosis or (3) patients older than 65 years with significant medical comorbidities. Nurick myelopathy grades and cervical radiographs were obtained preoperatively and at 3, 6, 12 and 24 months post-operatively. Perioperative complications, radiographic and clinical outcomes were assessed and reported in this paper. RESULTS: Forty-four (81%) of patients showed improvement in Nurick grade after surgery by a mean of 17 months. Ten patients (19%) demonstrated stable but unimproved myelopathy. Increasing pre-operative Nurick grade was associated with an improved post-operative outcome (p<0.02). Increasing duration of pre-operative myelopathy was associated with a decreased likelihood of myelopathy improvement (p<0.001). DISCUSSION: Multilevel cervical laminectomy with instrumented fusion for patients with CSM resulted in an improvement in myelopathy in the majority of cases. Efficacy was similar for patients who may not have tolerated an anterior decompression, such as elderly patients with significant medical comorbidities. Hardware-related complication rates were relatively low.

Effect of hyperglycemia on progressive paraparesis in a rat etastatic spinal tumor model.

OBJECT: Hyperglycemia has been shown to potentiate ischemic injury of the spinal cord by quenching vasodilators and potentiating tissue acidosis and free radical production. Steroid-induced hyperglycemia is a common event in the surgical management of metastatic epidural spinal cord compression (MESCC). The goal in this study was to determine whether experimentally induced hyperglycemia accelerates neurological decline in an established animal model of MESCC. METHODS: Sixteen Fischer 344 rats underwent a transabdominal approach for implantation of a CRL-1666 breast adenocarcinoma cell line within the vertebral body of L-6. After 72 hours of recovery from tumor implantation, the animals received intraperitoneal injections every 12 hours of either 2 g/kg dextrose in 5 ml 0.09% saline (hyperglycemia, 8 rats) or 5 ml 0.09% saline alone (normoglycemia, 8 rats). Weights were taken daily, and the hindlimb function was tested daily after tumor implantation by using the Basso-Beattie-Bresnahan (BBB) scale (score range 1-21). Animals were killed at time of paralysis (BBB Score < 7), and the volume of epidural tumor growth within the spinal canal was measured. To determine the degree of hyperglycemia induced by this dextrose regimen, a surrogate group of 10 Fischer 344 rats underwent intraperitoneal injections of 2 g/kg dextrose (5 rats) or 0.09% saline (5 rats) every 12 hours, and serum glucose levels were assessed 1, 3, 6, 8, 10, and 12 hours after injections for 24 hours. RESULTS: Dextrose versus saline injections resulted in elevated mean serum glucose at 3 (259 vs 103 microg/dl), 6 (219 vs 102 microg/dl), 8 (169 vs 102 microg/dl), and 10 hours (118 vs 99 microg/dl) after injection, returning to normal levels by 12 hours (96 vs 103 microg/dl) just prior to subsequent injection. All rats had normal hindlimb function for the first 8 days after tumor implantation. Hyperglycemic versus normoglycemic rats demonstrated a worsened median BBB score by postimplantation Day 9 (Score 20 vs 21, p = 0.023) through Day 16 (Score 8 vs 12, p = 0.047). Epidural tumor volume demonstrated a near-linear growth rate across both groups; however, hyperglycemic rats developed paralysis earlier (median 15.5 vs 17.5 days, p = 0.0035), with significantly less epidural tumor volume (2.75 +/- 0.38 cm(3) vs 4 +/- 0.41 cm(3), p < 0.001) at time of paralysis. CONCLUSIONS: In a rat model of metastatic epidural spinal cord compression, rats maintained in a hyperglycemic state experienced accelerated time to paralysis. Also, less epidural tumor volume was required to cause paralysis in hyperglycemic rats. These results suggest that hyperglycemic states may contribute to decreased spinal cord tolerance to compression resulting from MESCC. Clinical studies evaluating the effect of aggressive glucose control in patients with MESCC may be warranted.

Surgical treatment of cervical spondylotic myelopathy with anterior compression: a review of 67 cases.

OBJECT: In patients with cervical spondylotic myelopathy (CSM), ventral disease and loss of cervical lordosis are considered to be relative indications for anterior surgery. However, anterior decompression and fusion operations may be associated with an increased risk of swallowing difficulty and an increased risk of nonunion when extensive decompression is performed. The authors reviewed cases involving patients with CSM treated via an anterior approach, paying special attention to neurological outcome, fusion rates, and complications. METHODS: Retrospectively, 67 cases involving consecutive patients with CSM requiring an anterior decompression were reviewed: 46 patients underwent anterior surgery only (1-to3-level anterior cervical discectomy and fusion [ACDF] or 1-level corpectomy), and 21 patients who required > 3-level ACDF or > or = 2-level corpectomy underwent anterior surgery supplemented by a posterior instrumented fusion procedure. RESULTS: Postoperative improvement in Nurick grade was seen in 43 (93%) of 46 patients undergoing anterior decompression and fusion alone (p < 0.001) and in 17 (81%) of 21 patients undergoing anterior decompression and fusion with supplemental posterior fusion (p = 0.0015). The overall complication rate for this series was 25.4%. Interestingly, the overall complication rate was similar for both the lone anterior surgery and combined anterior-posterior groups, but the incidence of adjacent-segment disease was greater in the lone anterior surgery group. CONCLUSIONS: Significant improvement in Nurick grade can be achieved in patients who undergo anterior surgery for cervical myelopathy for primarily ventral disease or loss of cervical lordosis. In selected high-risk patients who undergo multilevel ventral decompression, supplemental posterior fixation and arthrodesis allows for low rates of construct failure with acceptable added morbidity.

Revision surgery for cervical spondylotic myelopathy: surgical results and outcome.

OBJECTIVE: The role of additional or revision surgery in patients with cervical spondylotic myelopathy (CSM) is challenging. Postoperative pseudoarthrosis, instability, hardware failure, and recurrent cervical stenosis are conditions that require detailed clinical and radiographic assessment to define the pathology and assess the need for surgical decompression and fusion. The purpose of this study is to assess the neurological outcome, radiological outcome, and complications of patients undergoing additional or revision surgery for CSM. METHODS: Between 2002 and 2006, 30 patients with CSM and postoperative pseudoarthrosis, instability, hardware failure, or recurrent stenosis underwent surgical decompression and stabilization. The specific procedure was selected according to each patient's medical condition, cervical sagittal alignment, and extent of stenosis. All patients underwent an anterior, posterior, or combined anterior and posterior decompression and instrumented fusion. The charts of these patients were reviewed to assess neurological and radiographic outcomes. RESULTS: Twenty-five patients (83%) improved postoperatively as measured by the Nurick Myelopathy Scale over a mean follow-up period of 19 months (range, 2-64 mo). The overall complication rate was 27%, consisting of transient monoradiculopathy (7%), dysphagia (10%), and infection (7%). The incidence of nonunion during the follow-up period was 3%. CONCLUSION: Although patients with CSM and postoperative pseudoarthrosis, instability, hardware failure, or junctional stenosis who require revision surgery may risk a substantial likelihood of surgical complications (25% in this series), a significant proportion of patients may experience improved neurological outcomes. In our experience, the cervical sagittal alignment and the extent of stenosis are critical factors to consider when selecting the eventual procedure.

Surgical resection plus adjuvant radiotherapy is superior to surgery or radiotherapy alone in the prevention of neurological decline in a rat metastatic spinal tumor model.

OBJECTIVE: The optimal management of spinal column metastatic disease is controversial. Furthermore, the literature lacks an accurate animal model to study the efficacy of surgical treatment options for spinal column metastases. We compared the efficacy of surgery, radiotherapy, or surgery plus adjuvant radiotherapy in a rat model of metastatic epidural spinal cord compression. METHODS: Thirty-two Fischer 344 rats underwent a transabdominal approach for implantation of a CRL-1666 breast adenocarcinoma cell line within the vertebral body of L6. Animals were randomly assigned to receive one of four treatments (n = 8 per group) 7 days after tumor implantation: 1) control: no treatment; 2) external beam radiation therapy (XRT) (total 20 Gy in 400-cGy daily fractions); 3) surgery: L6 vertebral corpectomy, tumor resection, and polymethyl methacrylate reconstruction; and 4) surgery + XRT: corpectomy and tumor resection followed by XRT (total 20 Gy in 400-cGy daily fractions) 72 hours after surgery. Hind-limb function was tested daily after treatment using the Basso-Beattie-Bresnahan (BBB) scale (range, 1-21). RESULTS: All animals (n = 32) demonstrated normal hind-limb function (BBB score, 21) on posttreatment Day 1. The XRT, surgery, and surgery + XRT groups all experienced a delay in onset of paresis versus the control group. Compared to the XRT group, the surgery group demonstrated greater median BBB scores on Days 3 (21 versus 20, P = 0.02) through 9 (12 versus 8, P = 0.002) after treatment. Compared with the surgery group, the surgery + XRT group demonstrated even greater median BBB scores on Days 6 (21 versus 19, P = 0.0008) through 11 (16 versus 8, P = 0.0001) after treatment. Median time to loss of ambulation (BBB

Lumbar synovial cysts: experience with nine cases.

Nine patients treated surgically for lumbar spinal synovial cyst were reviewed. Four patients had synovial, two had ganglion, one had posterior longitudinal ligament, and two had ligamentum flavum cyst. Synovial cysts had a single layer of epithelial cells in the inner layer of the cyst with continuity with the facet joint. Ganglion cyst had no continuity with the facet joint and epithelial lining was present in one and absent in one case. Posterior longitudinal ligament and ligamentum flavum cysts had no continuity with the facet joint and no epithelial lining. Magnetic resonance imaging showed the cysts better than computed tomography. All patients treated for nerve root compression or lumbar spinal canal narrowing. One patient suffered recurrence 1 year later and was reoperated. Operative results were excellent in six and good in three patients. Lumbar spinal synovial cysts should be considered in differential diagnosis of lumbar radiculopathy/neurogenic claudication and is surgically treatable.

Effects of magnesium sulphate following spinal cord injury in rats.

Neutrophil infiltration has been implicated in the secondary destructive pathomechanisms after initial mechanical injury to the spinal cord. Tissue myeloperoxidase (MPO) activity has been shown to be an exclusive indicator of the extent of post-traumatic neutrophil infiltration. We have studied the effect of magnesium sulphate on MPO activity after spinal cord injury in rats. Rats were randomly allocated into 5 groups. Group 1 was control and normal spinal cord samples were obtained after clinical examination. Forty g-cm contusion injury was introduced to Group 2. Group 3 was vehicle, 1 ml of physiological saline was injected post-trauma. Group 4 was given 30 mg/kg methylprednisolone sodium succinate (MPSS) immediately after trauma. Group 5 was given 600 mg/kg magnesium sulphate immediately after trauma. Animals were examined by inclined plane technique of Rivlin and Tator 24 h after trauma. Spinal cord samples obtained following clinical evaluations. Magnesium sulphate treatment improved early functional scores and decreased MPO activity. These findings revealed that magnesium sulphate treatment possesses neuroprotection on early clinical results and on neutrophil infiltration after acute contusion injury to the rat spinal cord.

Effect of immunomodulation with human interferon-beta on early functional recovery from experimental spinal cord injury.

STUDY DESIGN: Electron and light microscopic changes, neutrophil infiltration, and lipid peroxidation in the spinal cord and early neurologic examination were studied in rats. OBJECTIVE: To examine the effects of immunomodulator treatment with recombinant human interferon-beta after spinal cord contusion injury. SUMMARY OF BACKGROUND DATA: Immunomodulator treatment with interferon-beta has been the subject of extensive studies, but mainly in relation to multiple sclerosis. Recently, it was reported that interferon-beta possessed significant neuroprotection after experimental transient ischemic stroke. However, to our knowledge, there have been no previous reports about the neuroprotective effect of interferon-beta after spinal cord injury. METHODS: Rats were randomly allocated into 5 groups. Group 1 was control and after clinical examination, normal spinal cord samples were obtained. Group 2 was introduced 50 g/cm contusion injury. Group 3 was vehicle, immediately after trauma 1 mL of physiologic saline was injected. Group 4 was given 30 mg/kg methylprednisolone sodium succinate intraperitoneally immediately after trauma. Group 5 was given 1 x 10(7) IU interferon-beta immediately and 0.5 x 10(7) IU interferon-beta 4 hours after trauma. Animals were examined by inclined plane and Basso-Beattie-Bresnahan scale 24 hours after trauma. Spinal cord samples obtained following clinical evaluations. Neutrophil infiltration was evaluated by myeloperoxidase activity and lipid peroxidation was estimated by thiobarbituric acid test. Electron and light microscopic results were also performed to determine the effects of interferon-beta on tissue structure. RESULTS: Interferon-beta treatment improved neurologic outcome, which was supported by decreased myeloperoxidase activity and lipid peroxidation. Electron and light microscopic results also showed preservation of tissue structure in the treatment group. CONCLUSIONS: Immunomodulator treatment with interferon-beta possesses obvious neuroprotection after acute contusion injury to the rat spinal cord.