• Keywords
• SPINAL CORD/diseases *, SPINE/wounds and injuries *,
• MeSH
• Lumbar Vertebrae * MeSH
• Humans MeSH
• Spinal Cord Diseases * MeSH
• Spine * MeSH
• Spinal Injuries * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH

Experimental spinal cord transection injuries followed by spinal cord destruction and gentle resection of the destructed cord tissue necessarily lead to a gap between both of the cord stumps. For any attempts to reconstruct the cord or to bridge this gap by transplantation it may be useful to narrow or close the gap. This can be done by vertebral resection. The technique of upper lumbar vertebra resection in cats and rabbits with and without spinal cord lesion is presented. The spine is shortened by approximately 20 mm by spondylectomy. This length exceeds the 10-14 mm long gap in the spinal cord which is created by a spinal cord crush injury using haemostatic forceps and the subsequent destruction zone resection which is performed seven days later. The upper lumbar vertebra is resected by the posterior approach and the spinal cord is sufficiently exposed to perform spinal cord reconstruction experiments.

• MeSH
• Lumbar Vertebrae surgery   MeSH
• Spinal Fusion instrumentation   MeSH
• Cats MeSH
• Rabbits MeSH
• Spinal Cord surgery   MeSH
• Spinal Cord Injuries surgery   MeSH
• Animals MeSH
• Check Tag
• Cats MeSH
• Rabbits MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH

CONTEXT/OBJECTIVE: Traumatic damage to the cervical spinal cord is usually associated with a disruption of the autonomic nervous system (ANS) and impaired cardiovascular control both during and following exercise. The magnitude of the cardiovascular dysfunction remains unclear. The aim of the current study was to compare cardiovascular responses to peak voluntary exercise in individuals with tetraplegia and able-bodied participants. DESIGN: A case-control study. SUBJECTS: Twenty males with cervical spinal cord injury (SCI) as the Tetra group and 27 able-bodied males as the Control group were included in the study. OUTCOME MEASURES: Blood pressure (BP) response one minute after the peak exercise, peak heart rate (HRpeak), and peak oxygen consumption (VO2peak) on an arm crank ergometer were measured. In the second part of the study, 17 individuals of the Control group completed the Tetra group's workload protocol with the same parameters recorded. RESULTS: There was no increase in BP in response to the exercise in the Tetra group. Able-bodied individuals exhibited significantly increased post-exercise systolic BP after the maximal graded exercise test (123±16%) and after completion of the Tetra group's workload protocol (114±11%) as compared to pre-exercise. The Tetra group VO2peak was 59% and the HRpeak was 73% of the Control group VO2peak and HRpeak, respectively. CONCLUSIONS: BP did not increase following maximal arm crank exercise in males with a cervical SCI unlike the increases observed in the Control group. Some males in the Tetra group appeared to be at risk of severe hypotension following high intensity exercise, which can limit the ability to progressive increase and maintain high intensity exercise.

• Keywords
• Blood pressure, Cardiovascular system, Exercise, Spinal cord trauma, Tetraplegia,
• MeSH
• Exercise * MeSH
• Adult MeSH
• Cervical Vertebrae injuries   MeSH
• Blood Pressure * MeSH
• Humans MeSH
• Spinal Cord Injuries diagnosis   physiopathology   MeSH
• Oxygen Consumption * MeSH
• Heart Rate * MeSH
• Case-Control Studies MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

BACKGROUND: Spinal cord injury results in permanent neurological impairment and disability due to the absence of spontaneous regeneration. NG101, a recombinant human antibody, neutralises the neurite growth-inhibiting protein Nogo-A, promoting neural repair and motor recovery in animal models of spinal cord injury. We aimed to evaluate the efficacy of intrathecal NG101 on recovery in patients with acute cervical traumatic spinal cord injury. METHODS: This randomised, double-blind, placebo-controlled phase 2b clinical trial was done at 13 hospitals in the Czech Republic, Germany, Spain, and Switzerland. Patients aged 18-70 years with acute, complete or incomplete cervical spinal cord injury (neurological level of injury C1-C8) within 4-28 days of injury were eligible for inclusion. Participants were initially randomly assigned 1:1 to intrathecal treatment with 45 mg NG101 or placebo (phosphate-buffered saline); 18 months into the study, the ratio was adjusted to 3:1 to achieve a final distribution of 2:1 to improve enrolment and drug exposure. Randomisation was done using a centralised, computer-based randomisation system and was stratified according to nine distinct outcome categories with a validated upper extremity motor score (UEMS) prediction model based on clinical parameters at screening. Six intrathecal injections were administered every 5 days over 4 weeks, starting within 28 days of injury. Investigators, study personnel, and study participants were masked to treatment allocation. The primary outcome was change in UEMS at 6 months, analysed alongside safety in the full analysis set. The completed trial was registered at ClinicalTrials.gov, NCT03935321. FINDINGS: From May 20, 2019, to July 20, 2022, 463 patients with acute traumatic cervical spinal cord injury were screened, 334 were deemed ineligible and excluded, and 129 were randomly assigned to an intervention (80 patients in the NG101 group and 49 in the placebo group). The full analysis set comprised 78 patients from the NG101 group and 48 patients from the placebo group. 107 (85%) patients were male and 19 (15%) patients were female, with a median age of 51·5 years (IQR 30·0-60·0). Across all patients, the primary endpoint showed no significant difference between groups (with UEMS change at 6 months 1·37 [95% CI -1·44 to 4·18]; placebo group mean 19·20 [SD 11·78] at baseline and 30·91 [SD 15·49] at day 168; NG101 group mean 18·23 [SD 15·14] at baseline and 31·31 [19·54] at day 168). Treatment-related adverse events were similar between groups (nine in the NG101 group and six in the placebo group). 25 severe adverse events were reported: 18 in 11 (14%) patients in the NG101 group and seven in six (13%) patients in the placebo group. Although no treatment-related fatalities were reported in the NG101 group, one fatality not related to treatment occurred in the placebo group. Infections were the most common adverse event affecting 44 (92%) patients in the placebo group and 65 (83%) patients in the NG101 group. INTERPRETATION: NG101 did not improve UEMS in patients with acute spinal cord injury. Post-hoc subgroup analyses assessing UEMS and Spinal Cord Independence Measure of self-care in patients with motor-incomplete injury indicated potential beneficial effects that require investigation in future studies. FUNDING: EU program Horizon2020; Swiss State Secretariat for Education, Research and Innovation; Wings for Life; the Swiss Paraplegic Foundation; and the CeNeReg project of Wyss Zurich (University of Zurich and Eidgenössische Technische Hochschule Zurich).

• MeSH
• Adult MeSH
• Double-Blind Method MeSH
• Cervical Cord * injuries   MeSH
• Cervical Vertebrae MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Nogo Proteins * MeSH
• Spinal Cord Injuries * drug therapy   MeSH
• Aged MeSH
• Injections, Spinal * MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Clinical Trial, Phase II MeSH
• Multicenter Study MeSH
• Randomized Controlled Trial MeSH
• Names of Substances
• Nogo Proteins * MeSH

• Keywords
• SPINAL CORD/wounds and injuries *, WOUNDS AND INJURIES *,
• MeSH
• Humans MeSH
• Spinal Cord Injuries * MeSH
• Wounds and Injuries * MeSH
• Traumatology * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH

• Keywords
• SPINAL CORD/wounds and injuries *, SPINE/fractures *,
• MeSH
• Fractures, Bone * MeSH
• Spinal Fractures * MeSH
• Humans MeSH
• Spine * MeSH
• Spinal Cord Injuries * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH

• MeSH
• Humans MeSH
• Methods MeSH
• Spinal Cord Injuries surgery   MeSH
• Spinal Injuries surgery   MeSH
• Check Tag
• Humans MeSH
• Publication type
• English Abstract MeSH
• Journal Article MeSH

Purpose To develop a deep learning tool for the automatic segmentation of the spinal cord and intramedullary lesions in spinal cord injury (SCI) on T2-weighted MRI scans. Materials and Methods This retrospective study included MRI data acquired between July 2002 and February 2023. The data consisted of T2-weighted MRI scans acquired using different scanner manufacturers with various image resolutions (isotropic and anisotropic) and orientations (axial and sagittal). Patients had different lesion etiologies (traumatic, ischemic, and hemorrhagic) and lesion locations across the cervical, thoracic, and lumbar spine. A deep learning model, SCIseg (which is open source and accessible through the Spinal Cord Toolbox, version 6.2 and above), was trained in a three-phase process involving active learning for the automatic segmentation of intramedullary SCI lesions and the spinal cord. The segmentations from the proposed model were visually and quantitatively compared with those from three other open-source methods (PropSeg, DeepSeg, and contrast-agnostic, all part of the Spinal Cord Toolbox). The Wilcoxon signed rank test was used to compare quantitative MRI biomarkers of SCI (lesion volume, lesion length, and maximal axial damage ratio) derived from the manual reference standard lesion masks and biomarkers obtained automatically with SCIseg segmentations. Results The study included 191 patients with SCI (mean age, 48.1 years ± 17.9 [SD]; 142 [74%] male patients). SCIseg achieved a mean Dice score of 0.92 ± 0.07 and 0.61 ± 0.27 for spinal cord and SCI lesion segmentation, respectively. There was no evidence of a difference between lesion length (P = .42) and maximal axial damage ratio (P = .16) computed from manually annotated lesions and the lesion segmentations obtained using SCIseg. Conclusion SCIseg accurately segmented intramedullary lesions on a diverse dataset of T2-weighted MRI scans and automatically extracted clinically relevant lesion characteristics. Keywords: Spinal Cord, Trauma, Segmentation, MR Imaging, Supervised Learning, Convolutional Neural Network (CNN) Published under a CC BY 4.0 license.

• Keywords
• Convolutional Neural Network (CNN), MR Imaging, Segmentation, Spinal Cord, Supervised Learning, Trauma,
• MeSH
• Deep Learning * MeSH
• Adult MeSH
• Image Interpretation, Computer-Assisted methods   MeSH
• Middle Aged MeSH
• Humans MeSH
• Magnetic Resonance Imaging * methods   MeSH
• Spinal Cord Injuries * diagnostic imaging   pathology   MeSH
• Retrospective Studies MeSH
• Aged MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Research Support, N.I.H., Extramural MeSH

• MeSH
• Physics MeSH
• Physical Phenomena MeSH
• Cervical Vertebrae anatomy & histology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Ligaments anatomy & histology   MeSH
• Spinal Cord Injuries * MeSH
• Spinal Injuries * MeSH
• Elasticity * MeSH
• Aged MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Aged MeSH
• Publication type
• Journal Article MeSH

OBJECT: Hydrogels are nontoxic, chemically inert synthetic polymers with a high water content and large surface area that provide mechanical support for cells and axons when implanted into spinal cord tissue. METHODS: Macroporous hydrogels based on 2-hydroxyethyl methacrylate (HEMA) were prepared by radical copolymerization of monomers in the presence of fractionated NaCl particles. Male Wistar rats underwent complete spinal cord transection at the T-9 level. To bridge the lesion, positively charged HEMA hydrogels were implanted either immediately or 1 week after spinal cord transection; control animals were left untreated. Histological evaluation was performed 3 months after spinal cord transection to measure the volume of the pseudocyst cavities and the ingrowth of tissue elements into the hydrogels. RESULTS: The hydrogel implants adhered well to the spinal cord tissue. Histological evaluation showed ingrowth of connective tissue elements, blood vessels, neurofilaments, and Schwann cells into the hydrogels. Morphometric analysis of lesions showed a statistically significant reduction in pseudocyst volume in the treated animals compared with controls and in the delayed treatment group compared with the immediate treatment group (p < 0.001 and p < 0.05, respectively). CONCLUSIONS: Positively charged HEMA hydrogels can bridge a posttraumatic spinal cord cavity and provide a scaffold for the ingrowth of regenerating axons. The results indicate that delayed implantation can be more effective than immediate reconstructive surgery.

• MeSH
• Axons pathology   physiology   MeSH
• Biocompatible Materials chemistry   therapeutic use   MeSH
• Time Factors MeSH
• Cysts pathology   MeSH
• Wound Healing physiology   MeSH
• Hydrogels chemistry   therapeutic use   MeSH
• Rats MeSH
• Methacrylates chemistry   therapeutic use   MeSH
• Spinal Cord blood supply   pathology   MeSH
• Disease Models, Animal MeSH
• Neurofibrils ultrastructure   MeSH
• Paraplegia physiopathology   MeSH
• Connective Tissue pathology   MeSH
• Spinal Cord Injuries surgery   MeSH
• Rats, Wistar MeSH
• Nerve Regeneration physiology   MeSH
• Guided Tissue Regeneration MeSH
• Schwann Cells pathology   MeSH
• Tissue Scaffolds * MeSH
• Animals MeSH
• Check Tag
• Rats MeSH
• Male MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Comparative Study MeSH
• Names of Substances
• 2-(trimethylammonio)ethyl methacrylate MeSH Browser
• Biocompatible Materials MeSH
• Hydrogels MeSH
• hydroxyethyl methacrylate MeSH Browser
• Methacrylates MeSH