In the authors' experience, early detection and surgical removal in cases of symptomatic spinal OC is a key element for the best outcome. Posterior approaches are generally sufficient. The chronicity of symptoms may limit functional recovery postoperatively, especially with cervical and thoracic lesions.

DW MRI using large b-values could be used in differentiating acute infectious spondylitis from Modic type I.

BACKGROUNDMany patients with lumbar disc surgery experience postoperative back and radicular pain, delaying hospital discharge and resumption of normal activity. Some surgeons have used intraoperative epidural corticosteroids and local anesthetics to decrease pain following surgery for a herniated lumbar disc. Controversies still exist regarding the benefits of these drugs. The present study was meant to compare the effects of the intraoperative administration of epidural methylprednisolone and bupivacaine with that of normal saline (placebo) in lumbar disc surgery for postoperative pain control.PATIENTS AND METHODSOne hundred fifty patients with single level herniated nucleus pulposus (L4–L5 or L5–S1), which was refractory to 6 weeks of conservative management, were divided randomly in three groups. A standard hemipartial lamimectomy and discectomy was performed on all patients. At the end of the surgery, before the closure of fascia, 40 mg methylprednisolone with 3 mL normal saline for group 1, 2 mL bupivacaine 5% with 2 mL normal saline for group 2 and 4 mL normal saline for group 3 were instilled onto the epidural and exposed nerve root. Postoperative back and radicular pain intensity was assessed by a visual analogue scale (VAS) before and at 24, 48, 72, and 96 hours after surgery.RESULTSThere was no significant difference in back and radicular pain intensity between the three groups.CONCLUSIONIntraoperative administration of epidural methylprednisolone or bupivacaine does not relieve postoperative back and radicular pain.

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Meningiomas are the most prevalent intracranial tumors in human being. Although, majority of these cases are of benign nature, malignant behavior might be seen in a number of patients. This study aimed to investigate the status of estrogen receptor, progesterone receptor and Ki-67 labeling index in different grades of surgical intracranial meningiomas. In this prospective study, 50 patients with intracranial meningiomas were operated at the department of neurosurgery, Tabriz Teaching Imam Reza Hospital; from February 2010 through January 2012. Tumor grade was determined histopathologically according to the World Health Organization (WHO) subtyping system. Status of estrogen and progesterone receptor, as well as the Ki-67 labeling index was determined by immunohistochemical approach and graded as 0 (absent), 1 (weak), 2 (moderate) and 3 (strong). The group of patients comprised 15 males (30%) and 35 females (70%) with a mean age of 71.76 +/- 10.20 (range: 49-87) years. WHO grades I, II and III tumors were reported in 68, 22 and 10% of the cases, respectively. Estrogen receptor, progesterone receptor and Ki-67 labeling index were detected in 20% (all grade 1), 98% (grade 1: 2%, grade 2: 22%, grade 3: 74%) and 38% (grade 1: 6%, grade 2: 22% and grade 3: 10%) of the cases, respectively. The rate of grade 1 estrogen receptor was significantly higher in WHO grade I tumors (29%) than in WHO grades II and III (zero for both, p = 0.02). Grade 2 progesterone receptor was significantly higher in WHO grade II tumors (72.7%) vs. WHO grades I (8.8%) or III (0%). On the other hand, the rate of grade 3 progesterone receptor was significantly higher in WHO grades I (85.3%) and III (100%) tumors than in WHO grade II (27.3%) (p = 0.01). The rate of grade 3 Ki-67 labeling index was significantly higher in WHO grade III tumors (100%) than in WHO grades I and II (zero for both, p < 0.001). This study showed that firstly, estrogen receptor is seldom expressed in patients with meningioma; however, its presence means a good prognosis. Secondly, Ki-67 labeling index is a marker of poor prognosis in these patients. Thirdly, although, progesterone receptors are frequently expressed in meningioma, their prognostic role varies greatly and needs to be determined in further studies.

Background: Spinal cord injury (SCI) causes sensory, motor function and consists of a large proportion of patients that referred to trauma centers. Riluzole blocks the sodium channels and has possible supportive effects on the central nervous system. The aim of this study was to investigate the effect of riluzole on sensory and motor improvement and pain level in patients with acute SCI. Materials and Methods: In this clinical trial, sixty patients with acute SCI with A to C Frankel grade selected and randomly divided into two groups (each group included thirty patients). The two groups carefully matched in terms of age, sex, and Frankel class. Case group, in addition to conventional treatment, received riluzole and was evaluated after 6-week, 3-month, and 6-month periods in terms of sensory and motor status and compared with control group. Results: There were sixty patients divided into case and control groups. In the 6-week follow-up period and 3-month follow-up period, there was no significant difference between the two groups based on sensory and motor function (P = 0.053). In 6-month follow-up period, the difference was significant in case group (P = 0.001). Conclusion: The compressions between two groups demonstrated a significant difference in sensory and motor improvement and reduce pain level in patients with SCI.

Study DesignClinical trial study.PurposeThe aim of this study was to evaluate the effect of atorvastatin on sensory and motor function in patients with acute spinal cord injury.Overview of LiteratureThe prevalence and incidence of traumatic spinal cord injury are increasing. Statins are well established for use in hypercholesterolemia as well as during anti-inflammatory events.MethodsThis clinical trial study included 60 patients with acute spinal cord injury. These were randomly divided into two groups: the case group which received atorvastatin and also underwent surgical therapy and the control group which only underwent surgical therapy.ResultsThe severity of spinal cord lesions was evaluated based on the Frankel grade at three periods; this showed no significant difference between the two groups. Comparisons of the levels of pain between the groups based on a Visual Analog Scale system showed no significant difference at the three periods.ConclusionsWe observed no improvement at the 3- and 6-month follow-up in patients who were administered atorvastatin. However, a comparison of the two groups based on pain severity demonstrated a significant difference, suggesting that atorvastatin had a positive effect on patients with spinal cord injury.