Cervical tuberculosis treated with closed system abscess evacuation, and percutaneous laser disc decompression combined with secretome derived from umbilical cord mesenchymal stem cells: A case report.

INTRODUCTION AND IMPORTANCE: Minimal invasive surgery is preferred as it offers the same benefit with less tissue damage, especially in the cervical area where a lot of critical structure resides. Mesenchymal stem cells (MSCs) and its secretome provide a promising regenerative intervention to damaged tissue. We report a cervical spinal tuberculosis case with hemiparesis treated with minimally invasive surgery combined with a regenerative approach. CASE PRESENTATION: A 13-year-old boy presented with weakness in his left arm and left leg, accompanied by hemiparesthesia. The patient was unable to get up from bed, run, and jumpRadiology examination showed compression fracture, intervertebral disc retropulsion, spinal cord compression, and paravertebral cold abscess. The patient was treated with a single minimal invasive surgery consisting of closed system abscess evacuation, and percutaneous laser disc decompression combined with umbilical cord-derived mesenchymal stem cells. CLINICAL DISCUSSION: The pain, weakness, and numbness were gone two days after surgery. The patient could carry out normal activities, even doing sports such as mini soccer and badminton. This clinical improvement was obtained as he carried out some procedures. The cold abscess aspiration removed infection focus which prevents further vertebra destruction, PLDD which decompresses the retropulsed discs, and implantation of MSCs and secretomes which regenerate and strengthen the destructed bone and surrounding tissue. CONCLUSION: Closed system abscess evacuation, and percutaneous laser disc degeneration combined with secretome derived from UC-MSC are minimally-invasive strategies with promising results. Further studies are required to investigate its efficacy.

Remarkable recovery of lower extremity motor impairment in degenerative disc disease after percutaneous laser disc decompression combined with umbilical cord-derived mesenchymal stem cells implantation: A case report.

INTRODUCTION AND IMPORTANCE: Degenerative disc disease (DDD) is a common cause of low back pain, often leading to significant discomfort for patients. Current treatment options such as spinal fusion and physical therapy focus on symptom management rather than addressing the underlying degeneration. Percutaneous laser disc decompression (PLDD) has shown efficacy in treating radicular pain associated with disc herniation. However, there is a growing interest in utilizing tissue engineering approaches to reverse the pathological process of DDD. While results in larger vertebrates have been inconsistent, mesenchymal stem cells (MSCs) have demonstrated promise in small animal models. CASE PRESENTATION: A 46-year-old male presented with low back pain as well as urinary and fecal incontinence. Magnetic resonance imaging revealed disc bulging and foraminal stenosis at the L2-L4 levels. The patient underwent PLDD combined with umbilical cord-derived mesenchymal stem cells (UC-MSCs) injection, which later resulted in significant pain reduction and improved motor function. At six months of follow-up, the patient reported sustained pain relief and functional improvement. CLINICAL DISCUSSION: Percutaneous decompression techniques not only substantially reduce intradiscal pressure and facilitate the implosion of herniation inward but also concurrently expedite the degeneration of the intervertebral disc. Therefore, in addition to performing PLDD, stem cell injection is also carried out. This report underscores the importance of integrating mechanical and biological interventions for degenerative disc diseases, suggesting PLDD combined with MSC therapy as a promising strategy for managing DDD and potentially reversing its progression. We found that the patient had decreased pain postoperatively; he no longer complained of pain after six months of follow-up. CONCLUSION: PLDD combined with UC-MSCs might be an alternative treatment for patients with DDD. In addition to mechanical treatment, biological treatment with MSC injections is believed to be a potent combination for treating degenerative diseases such as DDD.

Comprehensive approach to degenerative spine with fragility spine fracture to improve quality of life: A case report study.

INTRODUCTION AND IMPORTANCE: Degeneration process occurs in humans after reaching their maximum potential. The degeneration process in the spine includes osteoporosis and degenerative disc disease, however, the conventional treatment causes many post-operative complications. Minimally invasive procedures have recently been carried out considering the same expected outcome and minimally injuring other tissues. Biological approaches using mesenchymal stem cells (MSCs) and secretomes are more promising for bone-related issues. We report a degenerative spine case managed with minimally invasive procedures combined with a biological approach. CASE PRESENTATION: An 83-year-old woman with a chief complaint of back pain after a fall, the physical examination found a painful area in the lower back accompanied by motor weakness in both legs, causing daily use of a wheelchair. Radiology examinations showed compression fracture, bulging disc, and osteoporosis. The patient underwent multiple minimally invasive procedures, namely vertebroplasty, MSCs implantation, PLDD, and secretome implantation. CLINICAL DISCUSSION: From 6 months of follow-up, it was found that the patient's posture getting better, the pain was reduced, and the results of the BMD examination were improved. The patient was able to carry out normal activities. This is due to vertebroplasty which strengthens the structure, PLDD which decompresses the disc, and implantation of MSCs and secretomes which improves the quality of the bone and surrounding tissue. CONCLUSION: The multi-minimally invasive procedure is potential for complex degenerative spine cases, particularly when combined with biological approaches using stem cells and secretomes in elderly, considering that complications from conventional treatment are quite common in elderly.

Doxycycline as a Potential MMP-1 Inhibitor for the Treatment of Spondylitis Tuberculosis: A Study in Rabbit Model.

Background: Tuberculosis (TB) of the spine is a highly disruptive disease, especially in underdeveloped and developing countries. This condition requires standard TB treatment for 9-18 months, which increases patient risk of drug-resistant TB. Consequently, this raises the concern of adopting additional therapies to shorten the treatment duration, improve the efficacy of anti-TB drugs, and further decrease damage in the affected tissues and organs. Matrix metalloproteinase- (MMP-) 1 is a key regulator of the destruction of the extracellular matrix and associated proteins and is a new potential target for TB treatment research. In the present study, we investigated the effects of doxycycline as an MMP-1 inhibitor in patients with spondylitis TB. Methods: Seventy-two New Zealand white rabbits with spondylitis TB were divided into 12 different groups based on incubation period (2, 4, 6, and 8 weeks) and doxycycline administration (without, 1 mg/kg body weight (BW), and 5 mg/kg BW). We observed the course of infection through the blood concentration changes and immunohistochemical examination of MMP-1, in addition to BTA staining, culture, polymerase chain reaction (PCR), and histopathological examination. Results: Treatment with once daily 5 mg/kg BW doxycycline significantly improved the blood MMP-1 level (p < 0.05) compared with the placebo and 1 mg/kg BW doxycycline. A significantly reduced ongoing infection and a higher healing rate were demonstrated in rabbits with a higher doxycycline dose through BTA staining, culture, PCR, and histopathology. Various degrees of vertebral endplates, vertebral body, and intervertebral disc destruction were observed in 32 rabbits with positive histopathological findings, in addition to positive inflammatory cell infiltration, characterized by numerous lymphocytes, macrophages, and epithelial cells, as well as abundant granulation tissue and necrotic substances proximal to the inoculated vertebral area. Bone and intervertebral disc destructions were more apparent in the untreated rabbits. Conclusion: Our study demonstrated the potential of doxycycline as an adjunctive treatment in spondylitis TB. However, limitations remain regarding the differences in the pathogenesis and virulence of Mycobacterium tuberculosis between rabbit and human systems, sample size, and the dose-dependent effect of doxycycline. Further studies are needed to address these issues.

Anatomically and Biomechanically Relevant Monolithic Total Disc Replacement Made of 3D-Printed Thermoplastic Polyurethane.

Various implant treatments, including total disc replacements, have been tried to treat lumbar intervertebral disc (IVD) degeneration, which is claimed to be the main contributor of lower back pain. The treatments, however, come with peripheral issues. This study proposes a novel approach that complies with the anatomical features of IVD, the so-called monolithic total disc replacement (MTDR). As the name suggests, the MTDR is a one-part device that consists of lattice and rigid structures to mimic the nucleus pulposus and annulus fibrosus, respectively. The MTDR can be made of two types of thermoplastic polyurethane (TPU 87A and TPU 95A) and fabricated using a 3D printing approach: fused filament fabrication. The MTDR design involves two configurations-the full lattice (FLC) and anatomy-based (ABC) configurations. The MTDR is evaluated in terms of its physical, mechanical, and cytotoxicity properties. The physical characterization includes the geometrical evaluations, wettability measurements, degradability tests, and swelling tests. The mechanical characterization comprises compressive tests of the materials, an analytical approach using the Voigt model of composite, and a finite element analysis. The cytotoxicity assays include the direct assay using hemocytometry and the indirect assay using a tetrazolium-based colorimetric (MTS) assay. The geometrical evaluation shows that the fabrication results are tolerable, and the two materials have good wettability and low degradation rates. The mechanical characterization shows that the ABC-MTDR has more similar mechanical properties to an IVD than the FLC-MTDR. The cytotoxicity assays prove that the materials are non-cytotoxic, allowing cells to grow on the surfaces of the materials.

Umbilical cord-derived mesenchymal stem cells implantation on Hemivertebra defect with three-year follow-up: Biological approach in congenital scoliosis treatment - A case report.

INTRODUCTION AND IMPORTANCE: Congenital scoliosis is abnormal vertebral column growth and development during embryogenesis. The most common type of congenital scoliosis is failure of growth which is called as hemivertebra. However, the recent surgical treatment of hemivertebra has several complications especially in young patient. The mesenchymal stem cells (MSCs) have been used to treat several bone problems including bone defect and may be have potential to treat the defect in hemiverterbra. We reported a hemivertebra treated by umbilical cord-derived MSCs (UC-MSCs). CASE PRESENTATION: A two-year-old boy presented with scoliosis deformity. The mother noticed the patient's deformity when he was 10th month of age as he learned to stand and progressed since then. There were no growth and development problems. On physical examination, the patient appeared to have scoliosis at lumbar level with bending to the right and asymmetry of waist fold with left shoulder depression. Based on X-ray and CT-Scan investigations, the patient was diagnosed with single fully segmented hemivertebra at 3rd lumbar level. 20 × 106 UC-MSCs were implanted into the bone defect of hemivertebra. CLINICAL DISCUSSION: At three-year follow-up, the X-ray and MRI investigations showed a decrease of Cobb angle and increase of hemivertebra ratio. These findings may be due to improvement of the bone defect, which is consistent with several studies that MSCs have abilities to promote bone formation by maintaining the osteoblast cells and improving vascularization. CONCLUSION: We found that MSCs therapy for hemivertebra represent a potential therapy to correct scoliosis curvature and prevent further curvature. Further clinical studies are required to investigate the efficacy of this therapy in hemivertebra.

The Use of 3D Polylactic Acid Scaffolds with Hydroxyapatite/Alginate Composite Injection and Mesenchymal Stem Cells as Laminoplasty Spacers in Rabbits.

Several types of laminoplasty spacer have been used to fill bone gaps and maintain a widened canal. A 3D scaffold can be used as an alternative spacer to minimize the risk observed in allografts or autografts. This study aims to evaluate the in vivo biocompatibility and tissue−scaffold integration of a polylactic acid (PLA) scaffold with the addition of alginate/hydroxyapatite (HA) and mesenchymal stem cell (MSc) injections. This is an experimental study with a pretest and post-test control group design. A total of 15 laminoplasty rabbit models were divided into five groups with variations in the autograft, PLA, HA/alginate, and MSc scaffold. In general, there were no signs of inflammation in most samples (47%), and there were no samples with areas of necrosis. There were no significant differences in the histopathological results and microstructural assessment between the five groups. This demonstrates that the synthetic scaffolds that we used had a similar tissue reaction and tissue integration profile as the autograft (p > 0.05). We recommend further translational studies in humans so that this biocompatible fabricated scaffold can be used to fill bone defects.

Integration of Umbilical Cord Mesenchymal Stem Cell Application in Hydroxyapatite-Based Scaffolds in the Treatment of Vertebral Bone Defect due to Spondylitis Tuberculosis: A Translational Study.

BACKGROUND: Vertebral bone defect represents one of the most commonly found skeletal problems in the spine. Progressive increase of vertebral involvement of skeletal tuberculosis (TB) is reported as the main cause, especially in developed countries. Conventional spinal fusion using bone graft has been associated with donor-site morbidity and complications. We reported the utilization of umbilical cord mesenchymal stem cells (UC-MSCs) combined with hydroxyapatite (HA) based scaffolds in treating vertebral bone defect due to spondylitis tuberculosis. MATERIALS AND METHODS: Three patients with tuberculous spondylitis in the thoracic, thoracolumbar, or lumbar region with vertebral body collapse of more than 50 percent were included. The patient underwent a 2-stage surgical procedure, consisting of debridement, decompression, and posterior stabilization in the first stage followed by anterior fusion using the lumbotomy approach at the second stage. Twenty million UC-MSCs combined with HA granules in 2 cc of saline were transplanted to fill the vertebral bone defect. Postoperative alkaline phosphatase level, quality of life, and radiological healing were evaluated at one-month, three-month, and six-month follow-up. RESULTS: The initial mean ALP level at one-month follow-up was 48.33 ± 8.50 U/L. This value increased at the three-month follow-up but decreased at the six-month follow-up time, 97 ± 8.19 U/L and 90.33 ± 4.16 U/L, respectively. Bone formation of 50-75% of the defect site with minimal fracture line was found. Increased bone formation comprising 75-100% of the total bone area was reported six months postoperation. A total score of the SF-36 questionnaire showed better progression in all 8 domains during the follow-up with the mean total score at six months of 2912.5 ± 116.67 from all patients. CONCLUSION: Umbilical cord mesenchymal stem cells combined with hydroxyapatite-based scaffold utilization represent a prospective alternative therapy for bone formation and regeneration of vertebral bone defect due to spondylitis tuberculosis. Further clinical investigations are needed to evaluate this new alternative.

The Effect of Mesenchymal Stem Cell-Enriched Scaffolds on MMP-8 and TGF-ß Levels of Vertebrae Postlaminoplasty in Rabbit Model.

INTRODUCTION: Some laminoplasty procedures still have restenosis because of bony-bridging failure of the laminar hinge. The present study aimed to determine the effect of mesenchymal stem cell (MSC)-enriched scaffolds on vertebral regeneration after laminoplasty on the basis of the number of osteoblasts, matrix metalloproteinase-8 (MMP-8), and transforming growth factor-beta (TGF-ß) levels. METHODS: Laminoplasty procedure using the Hirabayashi technique was conducted at the lumbar level in 32 rabbits that were divided into four and three groups of the control (C) and treatment groups, respectively, with different types of laminoplasty spacer (T1, autograft; T2, scaffold; and T3, scaffold with MSCs). Histopathological studies were conducted to calculate the number of osteoblasts and enzyme-linked immunosorbent assay tests to detect MMP-8 and TGF-ß 4 weeks after the surgery. RESULTS: The results showed a significant decrease in MMP-8 level in the T3 group compared with that in the control group (p < 0.05). A significant difference exists between the average number of newly formed osteoblasts in the control group compared with that in the T3 group (p < 0.05) with a higher mean blood TGF-ß level of all experimental groups compared with that of the control group (p = 0.58). CONCLUSION: The significant decrease in MMP-8 levels, increase in TGF-ß levels, and increased number of osteoblasts on MSC-seeded polylactic acid scaffolds could be useful to support the laminoplasty procedure to prevent restenosis because it was biocompatible and promoted the bone healing process.

Umbilical cord mesenchymal stromal cells as critical COVID-19 adjuvant therapy: A randomized controlled trial.

One of the main causes of acute respiratory distress syndrome in coronavirus disease 2019 (COVID-19) is cytokine storm, although the exact cause is still unknown. Umbilical cord mesenchymal stromal cells (UC-MSCs) influence proinflammatory T-helper 2 (Th2 ) cells to shift to an anti-inflammatory agent. To investigate efficacy of UC-MSC administration as adjuvant therapy in critically ill patients with COVID-19, we conducted a double-blind, multicentered, randomized controlled trial at four COVID-19 referral hospitals in Jakarta, Indonesia. This study included 40 randomly allocated critically ill patients with COVID-19; 20 patients received an intravenous infusion of 1 × 106 /kg body weight UC-MSCs in 100 ml saline (0.9%) solution (SS) and 20 patients received 100 ml 0.9% SS as the control group. All patients received standard therapy. The primary outcome was measured by survival rate and/or length of ventilator usage. The secondary outcome was measured by clinical and laboratory improvement, with serious adverse events. Our study showed the survival rate in the UC-MSCs group was 2.5 times higher than that in the control group (P = .047), which is 10 patients and 4 patients in the UC-MSCs and control groups, respectively. In patients with comorbidities, UC-MSC administration increased the survival rate by 4.5 times compared with controls. The length of stay in the intensive care unit and ventilator usage were not statistically significant, and no adverse events were reported. The application of infusion UC-MSCs significantly decreased interleukin 6 in the recovered patients (P = .023). Therefore, application of intravenous UC-MSCs as adjuvant treatment for critically ill patients with COVID-19 increases the survival rate by modulating the immune system toward an anti-inflammatory state.

Allogeneic umbilical cord-derived mesenchymal stem cells for treating critical-sized bone defects: a translational study.

INTRODUCTION: The current 'gold-standard' treatment of critical-sized bone defects (CSBDs) is autografts; however, they have drawbacks including lack of massive bone source donor site morbidity, incomplete remodeling, and the risk of infection. One potential treatment for treating CSBDs is bone marrow-derived mesenchymal stem cells (BM-MSCs). Previously, there were no studies regarding the use of human umbilical cord-mesenchymal stem cells (hUC-MSCs) for treating BDs. We aim to investigate the use of allogeneic hUC-MSCs for treating CSBDs. METHOD: We included subjects who were diagnosed with non-union fracture with CSBDs who agreed to undergo hUC-MSCs implantation. All patients were given allogeneic hUC-MSCs. All MSCs were obtained and cultured using the multiple-harvest explant method. Subjects were evaluated functionally using the Lower Extremity Functional Scale (LEFS) and radiologically by volume defect reduction. RESULT: A total of seven (3 male, 4 female) subjects were recruited for this study. The subjects age ranged from 14 to 62 years. All seven subjects had increased LEFS during the end of the follow-up period, indicating improved functional ability. The follow-up period ranged from 12 to 36 months. One subject had wound dehiscence and infection, and two subjects developed partial union. CONCLUSION: Umbilical cord mesenchymal stem cells are a potential new treatment for CSBDs. Additional studies with larger samples and control groups are required to further investigate the safety and efficacy of umbilical cord-derived mesenchymal stem cells for treating CSBDs.

Mechanisms of Cytotoxicity of Chemical Agents to Giant Cell Tumors: An In Vitro Study.

BACKGROUND: Various chemical agents have been used as an adjuvant treatment for giant cell tumor (GCT). However, the comparative effect of these chemicals remains unclear. METHODS: Multinucleated and spindle cells from cultured GCT patients, characterized by Nanog and Oct4 expression with RT-PCR, were directly administered, in vitro, with concentrations of 1%, 3%, and 5% of H2O2 and 75%, 85%, and 95% of ethanol for 10 minutes and concentrations of 0.003%, 0.005%, 0.01%, 0.03%, 0.1%, and 0.3% of H2O2 for 5 minutes and were incubated for 24 hours. Cell morphology, cell viability, and flow cytometry after various concentrations of H2O2 and ethanol exposure were assessed. RESULTS: H2O2 in all concentrations caused loss of cell viability. The number of viable cells after H2O2 exposure was related to the concentration-dependent effect. The initial viable spindle-shaped cell, multinucleated giant cell, and round-epithelioid cell had morphological changes into fragmented nonviable cells after exposure to H2O2. Flow cytometry using Annexin V showed cell death due to necrosis, with the highest concentration amounting to 0.3%. CONCLUSION: Administering local chemical adjuvants of H2O2 in vitro caused loss of viable GCT cells. The number of viable cells after H2O2 exposure was related to the concentration-dependent effect, whereas reducing concentration of H2O2 may cause loss of viability and morphology of cultured GCT cells with the apoptotic mechanism.

Vertebral body defects treated with umbilical-cord mesenchymal stem cells combined with hydroxyapatite scaffolds: The first case report.

INTRODUCTION: Vertebral body defects (VBDs) are one of the most frequent orthopaedic disorders. Such defects often require bone grafts or fusion procedures; however, both procedures often fail due to various factors. Mesenchymal stem cells (MSCs) have been used as a potential therapy to fill bone voids in bone defects, and they may be a potential treatment for VBDs. We reported VBDs treated with MSCs combined with hydroxyapatite scaffolds. PRESENTATION OF CASE: A 27-year-old female presented with recurrent back pain. She had a history of decompression and stabilization procedure one year ago after diagnosed with spinal tuberculosis. Initially, she felt back pain that intensifies with activity and relieved with rest. She noticed that the pain begun when once she heard a crack sound on her back while trying to get up from sitting position. There was no history of numbness or tingling sensation. There were no walking problems. Other functions, including micturition and defecation, were within normal limits. The patient firstly underwent lumbotomy procedure, and the images were all confirmed with fluoroscopy X-ray. The vertebrae went debridement, and finally, the bone defect was filled with 20 millions of umbilical cord-mesenchymal stem cells (UC-MSCs) combined with hydroxyapatite in 2 cc of saline. DISCUSSION: At three months postoperative, the patient could walk and had no pain. At six months of follow-up, no complications occurred. We also did not see any signs of neoplasm formation, which is consistent with previous studies that used MSCs for orthopaedic treatment. Moreover, no significant bone deformation or spinal cord compression was observed, which suggested the safety of the transplantation procedure. CONCLUSIONS: We found that MSCs combined with hydroxyapatite represents a potential therapy for bone regeneration in VBD. Further clinical studies are required to investigate the safety and efficacy of this combination of therapy in VBDs.

Significance of the Association between Disc Degeneration Changes on Imaging and Low Back Pain: A Review Article.

Low back pain (LBP) is a major health issue resulting in a huge economic burden on the community. It not only increases the medical costs directly, but also raises the disability and loss of productivity in the general population. Symptoms include local pain over the spinal area, pain radiating to the lower leg, stiffness, and muscle tension. LBP is strongly linked with intervertebral disc degeneration that is further associated with the disruption of the complex anatomy of nucleus pulposus, annulus fibrosus, and adjacent supporting structures of the spine. Change in the shape and intensity of nucleus pulposus, decreased disc height, disc herniation, vertebral endplate changes, presence of osteophyte, and posterior high intensity zones are degenerative changes found in imaging studies. Every feature is considered while grading the severity score. Modic changes, DEBIT (disc extension beyond interspace) score, and Pfirrmann criteria are some of the scoring criteria used for evaluating disc degeneration severity. Moreover, the total number and contiguous pattern of affected discs play a crucial role in symptom generation of back pain. Many studies have reported asymptomatic patients. Thus, the correlation between degeneration severity found in imaging study and symptom severity of LBP remain unclear. This review discusses and summarizes the available literature on the significance of the association between the severity of degenerative changes found in imaging study with the presence and intensity of LBP.

Cervical canal stenosis due to cervical spondylotic myelopathy C4-C5: A case report.

INTRODUCTION: Cervical spondylotic myelopathy (CSM) is a complex disease that presents with various signs and symptoms of cervical spinal cord impairment that may lead to significant clinical morbidity. PRESENTATION OF CASE: We present the case of a 50-year old man who was diagnosed with CSM. The patient underwent decompression and posterior stabilisation with open-door laminoplasty. At the 2-month follow-up, the pain subsided, function improved significantly, and weakness disappeared. The patient was also able to defecate and urinate normally. DISCUSSION: Cervical spondylotic myelopathy is a complex disease that may lead to significant clinical morbidity. The management requires an extensive knowledge of the anatomy, biomechanics, and surgical options. The variable clinical findings, radiological evidence and scoring system, such as JOA, are important for preoperative evaluation and individualising surgical planning. The choice of the most appropriate technique is affected by patient's clinical condition and radiologic findings as well as surgeon's experience. It is demonstrated that the Kurokawa-type laminoplasty that involves splitting the spinous processes in the midline offers the advantage of reduced bleeding as the lateral epidural venous plexus is not disturbed in comparison to that with the former Hirabayashi's expansive open-door laminoplasty. Moreover, the body symmetry is preserved; therefore, this procedure may be considered more anatomical and physiological. However, differences in the outcomes between the two approaches remain unknown. CONCLUSIONS: These findings suggest that the decompression and posterior stabilisation method may help achieve good patient outcomes.

Hemorrhagic Spinal Schwannoma in Thoracolumbar Area with Total Paraplegia.

Hemorrhagic schwannoma in the medulla spinalis is a rare occurrence. It is a variant of the slow-growing nerve sheath tumor that usually has subtle clinical symptoms. Injury to the spinal schwannoma that was previously suspected by spinal manipulations may accelerate the progression of symptoms and cause an acute presentation of paraplegia. We report a case of a patient that was suspected of an intradural tumor with paraparesis that initially refused treatment. Spinal manipulation procedures were performed outside of the hospital setting with subsequent advancement of paraparesis. A surgical intervention was performed, which found that the tumor mass has grown along with hemorrhage within the schwannoma. The bleeding within the mass may have caused the acute paraplegia that is rarely reported. The patient had a fair improvement on her lower motor extremity function from 1-2 to 3-4 out of 5 at six-month follow-up.

Improvement of renal function after human umbilical cord mesenchymal stem cell treatment on chronic renal failure and thoracic spinal cord entrapment: a case report.

BACKGROUND: Chronic renal failure is an important clinical problem with significant socioeconomic impact worldwide. Thoracic spinal cord entrapment induced by a metabolic yield deposit in patients with renal failure results in intrusion of nervous tissue and consequently loss of motor and sensory function. Human umbilical cord mesenchymal stem cells are immune naïve and they are able to differentiate into other phenotypes, including the neural lineage. Over the past decade, advances in the field of regenerative medicine allowed development of cell therapies suitable for kidney repair. Mesenchymal stem cell studies in animal models of chronic renal failure have uncovered a unique potential of these cells for improving function and regenerating the damaged kidney. CASE PRESENTATION: We report a case of a 62-year-old ethnic Indonesian woman previously diagnosed as having thoracic spinal cord entrapment with paraplegic condition and chronic renal failure on hemodialysis. She had diabetes mellitus that affected her kidneys and had chronic renal failure for 2 years, with creatinine level of 11 mg/dl, and no urinating since then. She was treated with human umbilical cord mesenchymal stem cell implantation protocol. This protocol consists of implantation of 16 million human umbilical cord mesenchymal stem cells intrathecally and 16 million human umbilical cord mesenchymal stem cells intravenously. Three weeks after first intrathecal and intravenous implantation she could move her toes and her kidney improved. Her creatinine level decreased to 9 mg/dl. Now after 8 months she can raise her legs and her creatinine level is 2 mg/dl with normal urinating. CONCLUSIONS: Human umbilical cord mesenchymal stem cell implantations led to significant improvement for spinal cord entrapment and kidney failure. The major histocompatibility in allogeneic implantation is an important issue to be addressed in the future.

Pedicle screw position changing policy for nerve injury problems during screw insertion on thoracolumbar compression fractures.

INTRODUCTION: Intraoperative neurophysiologic monitoring (IONM) had important role related to the complications in spinal surgery. Somatosensory Evoked Potential (SSEP), Transcranial electric Muscle Evoked Potentials (tceMEPs), and free run EMG are parameters used to asses functional integrity of the nervous system during surgical procedures. Once warning signal was recognized, surgeon have to make a precise decision to overcome that problem. PRESENTATION OF CASE: We present a 47-year old male with back pain due to compression fracture of thoracic vertebra T12 and lumbar vertebrae L1. While stabilizing through the posterior approach on the T11 and 12 as well as L2 and L3, the SSEP monitor showed 50% reduction in the waveform as the pedicle screw was inserted at the left side of T12. The instrumentation was changed into vertebra thoracal T10, T11, and vertebrae lumbar L2, L3. The SSEP normalized and post operatively pain decreased. After surgery there was no neurological deficit. DISCUSSION: Acute trauma as a result of spine instrumentation may provoke significant edema, with mass effect causing neurophysiological dysfunction. Administration of intravenous steroid would do at this stage, followed by constant infusion for following 24-48h, may help ameliorating the mass effect and improving the neurologic outcome. Alternatively, immediate pedicle screw changing policy showed absolute recovery of nerve injury. CONCLUSION: Insertion of pedicle screw in spinal surgery has a risk of complication that could be treated by pedicle screw changing policy.

Mycobacterium tuberculosis Contaminant Risk on Bone Marrow Aspiration Material from Iliac Bone Patients with Active Tuberculous Spondylitis.

There was a concern on Mycobacterium tuberculosis spreading to the bone marrow, when it was applied on tuberculous spine infection. This research aimed to study the probability of using autologous bone marrow as a source of mesenchymal stem cell for patients with tuberculous spondylitis. As many as nine patients with tuberculous spondylitis were used as samples. During the procedure, the vertebral lesion material and iliac bone marrow aspirates were obtained for acid fast staining, bacteria culture, and PCR (polymerase chain reaction) tests for Mycobacterium tuberculosis at the Clinical Microbiology Laboratory of Faculty of Medicine Universitas Indonesia. This research showed that there was a relationship between diagnostic confirmation of tuberculous spondylitis based on the PCR test and bacterial culture on the solid vertebral lesion material with the PCR test and bacterial culture from the bone marrow aspirates. If the diagnostic confirmation concluded positive results, then there was a higher probability that there would be a positive result for the bone marrow aspirates, so that it was not recommended to use autologous bone marrow as a source of mesenchymal stem cell for patients with tuberculous spondylitis unless the PCR and culture examination of the bone marrow showed a negative result.