This study aimed to investigate changes in the H-reflex recruitment curve in compressive radiculopathy, specifically assessing differences between symptomatic and asymptomatic limbs in patients with unilateral S1 radiculopathy through derived parameters. A total of 24 volunteers (15 male and 9 female, aged between 22 and 60 years) with confirmed nerve root compression in the L5/S1 segment participated. Nerve root compression was verified through clinical MRI examination and attributed to disc protrusion, spinal canal stenosis, or isthmic spondylolisthesis of L5/S1. Analysis revealed no difference in M-wave threshold intensity between symptomatic and non-symptomatic limbs. However, the H-reflex exhibited a trend toward increased threshold intensity in the symptomatic limb. Notably, a significant decrease in the slope of the H-reflex was observed on the symptomatic side, and the maximal H-reflex amplitude proved to be markedly different between the two limbs. The Hmax/Mmax ratio demonstrated a significant decrease in the symptomatic limb, indicating reduced effectiveness of signal translation. In conclusion, our findings emphasize the importance of H-reflex parameters in evaluating altered recruitment curves, offering valuable insights for neurological examinations. The observed differences in maximal values of M-wave, H-reflex, and their ratio in affected and unaffected limbs can enhance the diagnostic process for lumbosacral unilateral radiculopathy and contribute to a standardized approach in clinical assessments.
- MeSH
- dospělí MeSH
- elektromyografie MeSH
- H-reflex * fyziologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- radikulopatie * patofyziologie diagnóza MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Misdiagnosis is frequent in early motor neuron disease (MND), typically compressive radiculopathy, or in patients with restricted MND phenotype. In this retrospective, single tertiary centre study, we measured levels of neurofilament light (NfL) and phosphorylated neurofilament heavy (p-NfH) chain in cerebrospinal fluid (CSF) and of p-NfH in serum with commercially available ELISA kits and assessed their respective diagnostic performance as a marker of MND. The entire study population (n = 164) comprised 71 MND patients, 30 patients with compressive myelo- or radiculopathy, and 63 disease controls (DC). Among MND patients, we specified subgroups with only lower motoneuron involvement (MND-LMN, n = 15) and with confounding nerve roots or spinal cord compression (MND-C, n = 18), representing clinical diagnostic pitfalls. MND-LMN displayed significantly lower CSF NfL (p = 0.003) and p-NFH (p = 0.017), but not serum p-NfH (p = 0.347) levels compared to other MND patients (n = 56). The discriminative ability (area under the curve-AUC) of both CSF Nfs towards all MND patients was comparable to each other but significantly higher than that of p-NfH in serum (ps < 0.001). AUC of both CSF Nfs between MND-LMN and DC and also between MND-C and myelo-/radiculopathies were reduced, as compared to AUC between other MND and DC or myelo-/radiculopathies, respectively. Our results suggest that both Nfs in CSF represent a reliable diagnostic marker in a general MND population, fulfilling Awaji criteria. As for diagnostic pitfalls, and also for p-NfH in serum, their discriminative ability and, therefore, clinical utility appears to be limited.
- Klíčová slova
- Amyotrophic lateral sclerosis, Biomarker, Cerebrospinal fluid, Motor neuron disease, Neurofilament,
- MeSH
- biologické markery MeSH
- fenotyp MeSH
- intermediární filamenta MeSH
- lidé MeSH
- nemoci míchy * MeSH
- neurofilamentové proteiny MeSH
- onemocnění motorického neuronu * diagnóza MeSH
- radikulopatie * MeSH
- retrospektivní studie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- biologické markery MeSH
- neurofilamentové proteiny MeSH
Background and objectives: For the treatment of chronic unilateral radicular syndrome, there are various methods including three minimally invasive computed tomography (CT)-guided methods, namely, pulsed radiofrequency (PRF), transforaminal oxygen ozone therapy (TFOOT), and transforaminal epidural steroid injection (TFESI). Despite this, it is still unclear which of these methods is the best in terms of pain reduction and disability improvement. Therefore, the purpose of this study was to evaluate the short and long-term effectiveness of these methods by measuring pain relief using the visual analogue scale (VAS) and improvement in disability (per the Oswestry disability index (ODI)) in patients with chronic unilateral radicular syndrome at L5 or S1 that do not respond to conservative treatment. Materials and Methods: After screening 692 patients, we enrolled 178 subjects, each of whom underwent one of the above CT-guided procedures. The PRF settings were as follows: pulse width = 20 ms, f = 2 Hz, U = 45 V, Z ˂ 500 Ω, and interval = 2 × 120 s. For TFOOT, an injection of 4-5 mL of an O2-O3 mixture (24 μg/mL) was administered. For the TFESI, 1 mL of a corticosteroid (betamethasone dipropionate), 3 mL of an anaesthetic (bupivacaine hydrochloride), and a 0.5 mL mixture of a non-ionic contrast agent (Iomeron 300) were administered. Pain intensity was assessed with a questionnaire. Results: The data from 178 patients (PRF, n = 57; TFOOT, n = 69; TFESI, n = 52) who submitted correctly completed questionnaires in the third month of the follow-up period were used for statistical analysis. The median pre-treatment visual analogue scale (VAS) score in all groups was six points. Immediately after treatment, the largest decrease in the median VAS score was observed in the TFESI group, with a score of 3.5 points (a decrease of 41.7%). In the PRF and TFOOT groups, the median VAS score decreased to 4 and 5 points (decreases of 33% and 16.7%, respectively). The difference in the early (immediately after) post-treatment VAS score between the TFESI and TFOOT groups was statistically significant (p = 0.0152). At the third and sixth months after treatment, the median VAS score was five points in all groups, without a statistically significant difference (p > 0.05). Additionally, there were no significant differences in the Oswestry disability index (ODI) values among the groups at any of the follow-up visits. Finally, there were no significant effects of age or body mass index (BMI) on both treatment outcomes (maximum absolute value of Spearman's rank correlation coefficient = 0.193). Conclusions: Although the three methods are equally efficient in reducing pain over the entire follow-up, we observed that TFESI (a corticosteroid with a local anaesthetic) proved to be the most effective method for early post-treatment pain relief.
- Klíčová slova
- epidural injections, low back pain, ozone, pulsed radiofrequency treatment,
- MeSH
- injekce epidurální MeSH
- kyslík MeSH
- lidé MeSH
- ozon * terapeutické užití MeSH
- pulsní radiofrekvenční terapie * MeSH
- radikulopatie * farmakoterapie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- kyslík MeSH
- ozon * MeSH
OBJECTIVES: Assessment of neuropathic pain in chronic low back syndromes is important. However, there is currently no gold standard for its diagnosis. The aim of this observational cross-sectional study was to assess the neuropathic component of pain in various chronic low back pain syndromes using a range of diagnostic tests. MATERIALS AND METHODS: Included in this study were 63 patients with chronic axial low back pain (ALBP), 48 patients with chronic radicular syndromes (CRS) comprising 23 with discogenic compression (CDRS) and 25 with lumbar spinal stenosis (LSS), and 74 controls. PainDETECT questionnaire (PDQ), quantitative sensory testing (QST), and skin biopsy with evaluation of intraepidermal nerve fiber density (IENFD) were used to assess the neuropathic pain component. RESULTS: Positive PDQ (≥19) was obtained more frequently in patients with CDRS and LSS (26.1% and 12.0%, respectively) compared with patients with ALBP (1.6%, P<0.001). The proportion of patients with sensory loss confirmed by QST was lowest in the ALBP subgroup (23.8%) compared with CDRS (47.8%), and LSS (68.0%) subgroups (P<0.001). A reduction in IENFD was disclosed in a proportion of up to 52.0% of affected roots in patients with CRS. DISCUSSION: Neuropathic pain is quite frequent in CRS, and QST reveals sensory loss as a frequent abnormality in patients with CRS. Using a cut-off value of 19, PDQ identified a neuropathic component in a relatively low proportion of patients with CRS. CRS may be associated with a reduction in IENFD.
- MeSH
- biopsie MeSH
- dospělí MeSH
- komprese míchy komplikace MeSH
- kůže patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- lumbalgie komplikace diagnóza patologie MeSH
- měření bolesti MeSH
- míšní kořeny patologie MeSH
- mladý dospělý MeSH
- nervová vlákna patologie MeSH
- neuralgie komplikace diagnóza patologie MeSH
- neurologické vyšetření MeSH
- poruchy senzitivity diagnóza etiologie MeSH
- průřezové studie MeSH
- radikulopatie etiologie patologie MeSH
- senioři MeSH
- spinální stenóza komplikace MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- práce podpořená grantem MeSH
Ventral root avulsion (VRA) triggers a strong glial reaction which contributes to neuronal loss, as well as to synaptic detachment. To overcome the degenerative effects of VRA, treatments with neurotrophic factors and stem cells have been proposed. Thus, we investigated neuroprotection elicited by human embryonic stem cells (hESC), modified to overexpress a human fibroblast growth factor 2 (FGF-2), on motoneurons subjected to VRA. Lewis rats were submitted to VRA (L4-L6) and hESC/FGF-2 were applied to the injury site using a fibrin scaffold. The spinal cords were processed to evaluate neuronal survival, synaptic stability, and glial reactivity two weeks post lesion. Then, qRT-PCR was used to assess gene expression of β2-microglobulin (β2m), TNFα, IL1β, IL6 and IL10 in the spinal cord in vivo and FGF2 mRNA levels in hESC in vitro. The results indicate that hESC overexpressing FGF2 significantly rescued avulsed motoneurons, preserving synaptic covering and reducing astroglial reactivity. The cells were also shown to express BDNF and GDNF at the site of injury. Additionally, engraftment of hESC led to a significant reduction in mRNA levels of TNFα at the spinal cord ventral horn, indicating their immunomodulatory properties. Overall, the present data suggest that hESC overexpressing FGF2 are neuroprotective and can shift gene expression towards an anti-inflammatory environment.
- Klíčová slova
- Embryonic stem cells, Fibroblast growth factor 2, Motoneurons, Neuroprotection, Neurotrophic factors, Ventral root avulsion,
- MeSH
- doxycyklin terapeutické užití MeSH
- fibrinová tkáňová adheziva toxicita MeSH
- fibroblastový růstový faktor 2 genetika metabolismus MeSH
- genetické vektory fyziologie MeSH
- krysa rodu Rattus MeSH
- lidé MeSH
- lidské embryonální kmenové buňky metabolismus transplantace MeSH
- míšní kořeny patologie MeSH
- modely nemocí na zvířatech MeSH
- motorické neurony metabolismus patologie MeSH
- neuroglie účinky léků metabolismus MeSH
- pohyb buněk MeSH
- potkani inbrední LEW MeSH
- proteiny nervové tkáně metabolismus MeSH
- radikulopatie chemicky indukované chirurgie MeSH
- regulace genové exprese účinky léků genetika MeSH
- tkáňová adheziva toxicita MeSH
- viabilita buněk účinky léků genetika MeSH
- zvířata MeSH
- Check Tag
- krysa rodu Rattus MeSH
- lidé MeSH
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Názvy látek
- doxycyklin MeSH
- fibrinová tkáňová adheziva MeSH
- fibroblastový růstový faktor 2 MeSH
- proteiny nervové tkáně MeSH
- tkáňová adheziva MeSH
OBJECTIVE: Brachial plexus injuries are usually severe and involve the entire brachial plexus, sometimes occurring with root avulsions. Imaging and electrodiagnostic studies are an essential part of the lesion evaluation; however, the results sometimes show a discrepancy. The cutaneous silent period (SP) is a spinal inhibitory reflex mediated by small-diameter A-delta nociceptive fibers. The aim of the study was to determine if cutaneous SP testing may serve as a useful aid in evaluation of brachial plexus injury and/or in the diagnosis of root avulsion. METHODS: In 19 patients with traumatic brachial plexus injury (15 males, age 18-62 years) we performed a clinical examination, CT myelography and neurophysiological testing. A needle EMG was obtained from muscles supplied by C5-T1 myotomes. Cutaneous SP was recorded after painful stimuli were delivered to the thumb (C6 dermatome), middle (C7) and little (C8) fingers while subjects maintained voluntary contraction of intrinsic hand muscles. RESULTS: Electrodiagnostic and imaging studies confirmed root avulsion (partial or total) maximally involving C5, C6 roots in 12 patients, whereas only in 4 of them the cutaneous SP was partially absent. In the remaining subjects, the cutaneous SP was preserved. CONCLUSION: In brachial plexopathy even with plurisegmental root avulsion, the cutaneous SP was mostly preserved. This method cannot be recommended as a reliable test for diagnosis of single root avulsion; however, it can provide a quick physiological confirmation of functional afferent A-delta fibers through damaged roots and/or trunks. The clinicians may add this test to the diagnosis of spinal cord dysfunction.
- Klíčová slova
- A-delta fibers, Brachial plexopathy, Cutaneous silent period, Electromyography, Root avulsion,
- MeSH
- dospělí MeSH
- elektromyografie metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- neuropatie brachiálního plexu komplikace diagnóza MeSH
- plexus brachialis zranění MeSH
- radikulopatie diagnóza etiologie MeSH
- reakční čas * MeSH
- reflex * MeSH
- svalová kontrakce MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
BACKGROUND: The aim of this study was to evaluate the results achieved using various surgical techniques in patients with partial and total obstetrical brachial plexus palsy. METHODS: From 2000 to 2013, 33 patients with obstetrical brachial plexus injury underwent surgery. Twenty had follow-up periods greater than 24 months and met the criteria for inclusion in the study. All patients were evaluated using the Active Movement Scale. RESULTS: The outcomes of different nerve reconstructive procedures including nerve transfers, nerve grafting after neuroma resection and end-to-side neurorrhaphy are presented. The overall success rate in upper plexus birth injury was 80 % in shoulder abduction, 50 % in external rotation and 81.8 % in elbow flexion with median follow-ups of 36 months. Success rate in complete paralysis was 87 % in finger and thumb flexion, 87 % in shoulder abduction and 75 % in elbow flexion; the median follow-up was 46 months. Useful reanimation of the hand was obtained in both patients who underwent end-to-side neurotization. CONCLUSION: Improved function can be obtained in infants with obstetrical brachial plexus injury with early surgical reconstruction.
- MeSH
- kojenec MeSH
- lidé MeSH
- nervový transfer metody MeSH
- neurochirurgické výkony metody MeSH
- neuropatie brachiálního plexu etiologie chirurgie MeSH
- plexus brachialis zranění MeSH
- porodní poranění novorozence komplikace chirurgie MeSH
- radikulopatie patologie chirurgie MeSH
- výsledek terapie * MeSH
- zákroky plastické chirurgie metody MeSH
- Check Tag
- kojenec MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
STUDY DESIGN: A prospective study. OBJECTIVE: The aim of this study was to compare the 3 different methods of interbody fusion of the cervical spine-autograft in stand-alone technique, autograft with anterior plate, and polyetheretherketone cage supported by anterior plate. The clinical and radiological data obtained were analyzed and discussed. SUMMARY OF BACKGROUND DATA: Although degenerative cervical spine disease has been treated by an anterior approach for more than 50 years, there is not one generally accepted operative approach. There is a very low-quality evidence of little or no difference in pain relief between each of the techniques. Iliac crest autograft still seems to be the "gold standard" for interbody fusion. METHODS: Prospective study collecting clinical and radiological data of 81 patients undergoing anterior cervical interbody fusion, in which the interbody fusion of 1 or 2 motion segments from C3 to C7 was done by any of the 3 techniques--stand-alone insertion of autograft (group 1: 28 patients), autograft and anterior plate (group 2: 18 patients), and polyetheretherketone cage filled with beta-tricalcium phosphate and plate (group 3: 29 patients). Patients were followed for 2 years after surgery. RESULTS: Significant interaction of relative height in the segment and time was found (P < 0.001). The values of the relative height of stand-alone autograft dropped below 95% of initial height and the values of the other 2 groups remained above 105%. Significant interaction of time and group was found for Cobb S angles (P < 0.001). Values of group 1 decreased substantially and remained significantly lower than values of other 2 groups. Fusion rate was 100% in all groups. Neck Disability Index group and time interaction was found (P = 0.023). During postoperative follow-up, group 1 scored in all controls higher than the other 2 groups, but differences were not significant. Visual analogue scale showed effect of time (P < 0.001). This was due to a smaller improvement of patients in group 1 during the whole follow-up in comparison with the other 2 groups. Highest proportion of unsatisfied patients was in group 1 compared with the other 2 groups after 2 years (P = 0.034). CONCLUSION: Significantly worse radiological and clinical results after 2 years of follow-up were achieved using stand-alone autograft technique in comparison with autograft supported by anterior plating similarly as in comparison with cage implant and anterior plating. Using artificial fusion substrate together with plate and cage can offer the same clinical and radiological results such as iliac autograft and plating. Anterior plating seems to be an important factor influencing the postoperative cervical spine alignment and also the clinical outcome.
- MeSH
- autologní transplantace MeSH
- benzofenony MeSH
- chirurgická dekomprese MeSH
- dospělí MeSH
- fúze páteře přístrojové vybavení metody MeSH
- interní fixátory MeSH
- ketony MeSH
- kostní destičky MeSH
- krční obratle diagnostické zobrazování chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- následné studie MeSH
- obnova funkce MeSH
- osteofytóza páteře chirurgie MeSH
- polyethylenglykoly MeSH
- polymery MeSH
- prospektivní studie MeSH
- radikulopatie chirurgie MeSH
- radiografie MeSH
- reoperace MeSH
- senioři MeSH
- spondylóza chirurgie MeSH
- transplantace kostí MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky MeSH
- srovnávací studie MeSH
- Názvy látek
- benzofenony MeSH
- ketony MeSH
- polyetheretherketone MeSH Prohlížeč
- polyethylenglykoly MeSH
- polymery MeSH
STUDY DESIGN: This report characterises a 25 year old male patient with a complete burst fracture of the fifth lumbar vertebra with dislocation. He was treated by posterior surgery with transpedicular instrumentation and an expandable cage from the posterior approach. OBJECTIVES: Burst fractures of the fifth lumbar vertebra are extremely rare. Patients with positive neurological findings should be treated by the posterior approach. This surgery consists of reduction, decompression, transpedicular stabilisation and fusion. MATERIALS AND METHODS: The young man in our report was treated by posterior surgery only. It consisted of laminectomy, suture of the thecal sac tear, discectomies and subtotal removal of the fifth lumbar vertebra. Repositioning was carried out simultaneously with support using Synex TM Synthes USA telescopic cage and SOCON TM Aesculap Germany transpedicular fixator. RESULTS: The patient suffered neither wound complications nor instrumentation failure. He is currently able to walk with the help of peroneal bands but without crutches. CONCLUSIONS: Treatment of fractures of the fifth lumbar vertebra depends on fracture type and neurological findings. Conservative management of this condition is appropriate provided there is no neurological damage and canal stenosis and deformity is minimal. Surgical treatment of burst lumbar fractures with neurological deficit is strongly recommended. The optimum treatment remains debatable.
- MeSH
- bederní obratle diagnostické zobrazování zranění chirurgie MeSH
- chirurgická dekomprese přístrojové vybavení metody MeSH
- dospělí MeSH
- fraktury páteře diagnostické zobrazování patologie chirurgie MeSH
- fúze páteře přístrojové vybavení metody MeSH
- interní fixátory trendy MeSH
- laminektomie metody MeSH
- lidé MeSH
- lumbalgie MeSH
- míšní kořeny zranění patofyziologie MeSH
- neurochirurgické výkony přístrojové vybavení metody MeSH
- neuropatie nervus peroneus etiologie patofyziologie MeSH
- počítačová rentgenová tomografie MeSH
- pokus o sebevraždu MeSH
- polyradikulopatie etiologie patologie prevence a kontrola MeSH
- radikulopatie etiologie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
Spondylotic cervical cord compression detected by imaging methods is a prerequisite for the clinical diagnosis of spondylotic cervical myelopathy (SCM). Little is known about the spontaneous course and prognosis of clinically "silent" presymptomatic spondylotic cervical cord compression (P-SCCC). The aim of the present study was to update a previously published model predictive for the development of clinically symptomatic SCM, and to assess the early and late risks of this event in a larger cohort of P-SCCC subjects. A group of 199 patients (94 women, 105 men, median age 51 years) with magnetic resonance signs of spondylotic cervical cord compression, but without clear clinical signs of myelopathy, was followed prospectively for at least 2 years (range 2-12 years). Various demographic, clinical, imaging, and electrophysiological parameters were correlated with the time for the development of symptomatic SCM. Clinical evidence of the first signs and symptoms of SCM within the follow-up period was found in 45 patients (22.6%). The 25th percentile time to clinically manifested myelopathy was 48.4 months, and symptomatic SCM developed within 12 months in 16 patients (35.5%). The presence of symptomatic cervical radiculopathy and electrophysiological abnormalities of cervical cord dysfunction detected by somatosensory or motor-evoked potentials were associated with time-to-SCM development and early development (< or =12 months) of SCM, while MRI hyperintensity predicted later (>12 months) progression to symptomatic SCM. The multivariate predictive model based on these variables correctly predicted early progression into SCM in 81.4% of the cases. In conclusion, electrophysiological abnormalities of cervical cord dysfunction together with clinical signs of cervical radiculopathy and MRI hyperintensity are useful predictors of early progression into symptomatic SCM in patients with P-SCCC. Electrophysiological evaluation of cervical cord dysfunction in patients with cervical radiculopathy or back pain is valuable. Meticulous follow-up is justified in high-risk P-SCCC cases.
- MeSH
- dospělí MeSH
- elektrodiagnostika metody MeSH
- evokované potenciály fyziologie MeSH
- kohortové studie MeSH
- komprese míchy diagnóza patofyziologie MeSH
- krční obratle patologie patofyziologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- mícha patofyziologie MeSH
- modely neurologické * MeSH
- nervové dráhy patofyziologie MeSH
- osteofytóza páteře diagnóza patofyziologie MeSH
- prediktivní hodnota testů MeSH
- prognóza MeSH
- progrese nemoci MeSH
- prospektivní studie MeSH
- radikulopatie diagnóza patofyziologie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH