Clinical therapeutic guideline for neurorestoration in spinal cord injury (Chinese version 2016)

Feng, Yu; Sun, Tiansheng; Chen, Lin; Xie, Jiaxin; Zhang, Zhicheng; Huang, Hongyun; He, Xijing

doi:10.2147/jn.s119581

Cited by 13 publications

(16 citation statements)

References 60 publications

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“…After 6 months of implantation, the CPN cement clump maintained its monolithic shape and with no apparent disintegration in the cement, but bioresorption occurred at the microscale because the new bone ingrowth to the resorption sites were at the scale of tens of micrometres (Figure 8). These results suggested that the bioresorption rate of CPN was moderate and matched the progression of new bone ingrowth and can be used for fixation in the early stages of spinal injury [27]; this bioresorption behaviour is desirable for maintaining the mechanical stability of CICPS fixation during the progress of the degradation of CPN. We, therefore, expect that CPN would not cause loss of the CICPS fixation before the fracture is healed.…”

Section: Discussionmentioning

confidence: 82%

A novel calcium phosphate–based nanocomposite for the augmentation of cement-injectable cannulated pedicle screws fixation: A cadaver and biomechanical study

Sun

Liu

et al. 2020

Journal of Orthopaedic Translation

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Background/objectiveBoth polymethylmethacrylate (PMMA) and traditional calcium phosphate–based cements have some deficiencies as augmentation materials for pedicle screw fixation. Here, a novel calcium phosphate–based nanocomposite (CPN) for the augmentation of pedicle screw fixation was developed based on previous study, and the handling properties, biomechanical performance, and biodegradation behaviour of CPN were evaluated and compared with clinical PMMA by means of a cadaver study and animal tests.MethodsBone mineral density of the lumbar vertebrae was tested. Pedicle screws were placed into the lumbar vertebrae under the guidance of three dimensionally printed templates; each of which was designed based on computed tomography (CT) reconstruction of each vertebrae and augmented with either PMMA or CPN. X-ray and CT scan were used to evaluate the accuracy of screw placement and dispersion as well as interdigitation of bone cement. The axial pull-out strength and maximum torque were tested using a mechanical testing machine. Degradation behaviour of CPN was evaluated by in vitro immersion tests for 8 weeks and in vivo rabbit femur defect model for up to 6 months, respectively.ResultsStandard mechanical tests revealed that PMMA was much stronger than CPN after setting (compressive strength 95 vs. 49 MPa, respectively, p < 0.001). Results of the projection area and volume distribution of cement along the distal end of the screws revealed that CPN exhibited unique dispersing and interdigitation abilities compared with PMMA. Specifically, CPN dispersed uniformly and symmetrically along the screw, while PMMA was limited to the proximal part of the screw. Axial pull-out test results showed that the axial pull-out strengths of CPN- and PMMA-augmented pedicle screws were similar (1199 ± 225 N vs 1337 ± 483 N, respectively) and not significantly different (p = 0.47), although CPN was an intrinsically weaker material than PMMA. Similarly, CPN showed average torque values of 0.72 ± 0.31 N·m slightly lower than those of PMMA (0.96 ± 0.23 N·m), but statistically there was no significant difference between CPN and PMMA (p = 0.21). In a rabbit model of femoral bone defect, the implanted CPN maintained its clear boundary and there is no disintegration in the cement clump after 20 days and 24 weeks, and there was moderate bioabsorption of CPN and clearly new bone ingrowth at the absorbed sites after 24 weeks.ConclusionA new nanocomposite cement CPN, designed for replacing the nondegradable PMMA cement and overcoming the mechanical inferiority of calcium phosphate cement, was evaluated for its biomechanical and biodegradation behaviours in cement-injectable cannulated pedicle screws (CICPS) application. Although CPN is a mechanically weaker material than PMMA, CPN demonstrates similar biomechanical properties to PMMA in the application of augmentation for CICPS fixation in cadaveric vertebrae. This improvement in biomechanical property is attributed to a better dispersion and interdigitation mode of CPN. In a...

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Section: Discussionmentioning

confidence: 82%

A novel calcium phosphate–based nanocomposite for the augmentation of cement-injectable cannulated pedicle screws fixation: A cadaver and biomechanical study

Sun

Liu

et al. 2020

Journal of Orthopaedic Translation

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“…Saadoun found that lower ISP and higher SCCP were thought to contribute to the recovery of neurological function by measuring changes in ISP and assessing the AIS grade [10]. Feng pointed out that spinal cord decompression may contribute to the neurological recovery in additional to bony decompression [11].…”

Section: Selection Of Surgical Methodsmentioning

confidence: 99%

Early durotomy with duroplasty for severe adult spinal cord injury without radiographic abnormality: a novel concept and method of surgical decompression

et al. 2019

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Purpose Treatment options for adult spinal cord injury without radiographic abnormality (ASCIWORA) varied. Compression of ASCIWORA may more likely result from spinal cord lesions such as edema and hemorrhage or contusion. This study aimed to explore the clinical effect of early durotomy with duroplasty decompression in the treatment of severe ASCIWORA. Methods Data of 16 patients with ASCIWORA who underwent early (< 72 h) posterior laminectomy followed by durotomy with duroplasty decompression from June 2015 to January 2017 were retrospectively analyzed. Patients' prognosis was analyzed by American Spinal Injury Association Impairment Scale (AIS) grades and scores. In 3 patients, intraspinal pressure (ISP) was continuously monitored for 1 week. Results Cervical magnetic resonance imaging (MRI) revealed spinal cord edema in 9 patients and suspected hemorrhage or contusion in 7 cases. Pathological manifestations of spinal cord injury found during the operation were consistent with preoperative MRI findings. Of the 16 cases, AIS grade was improved by 1 grade in 3 cases, 2 grades in 11 cases, and 3 grades in 1 case. The AIS scores at the last follow-up were significantly higher than preoperative scores. There was a high level of ISP after laminectomy, whereas ISP continued to decrease steadily after durotomy. Conclusions Durotomy helps thoroughly decompress the spinal cord and improve cerebrospinal fluid circulation in severe ASCI-WORA cases. Cervical MRI and pathological investigation of the spinal cord can be used to evaluate and predict the prognosis of ASCIWORA patients. ISP monitoring is an effective method for evaluating intramedullary pressure and decompression.

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“…Aghayan et al reported a draft of Iranian national guidelines for cell therapy manufacturing, which covered all aspects, including ethical issues, manufacturing processes, quality control, transportation, harvesting, storage, and release of cell-based products [66]. Huang [68]. Xiao et al reported on neurorestorative clinical application standards for the culture and quality control of olfactory ensheathing cells [69], which included standardized training and management procedures for laboratory operators; standardized use and management of materials and equipment; standardized collection, culture, and proliferation of olfactory ensheathing cells obtained from fetal olfactory bulbs; standardized management for cell preservation, transport, and related safeguard measures; and the standardization of a clean environment, routine maintenance, and related tests and examinations.…”

Section: Guidelinesmentioning

confidence: 99%

2017 Yearbook of Neurorestoratology

Huang¹,

Skaper

Mao³

et al. 2018

Journal of Neurorestoratology

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In 2016 we published the first Yearbook of Neurorestoratology, which summarized pathogenesis in nervous system disease and damage, as well as neurorestorative mechanisms and neurorestorative therapeutic results. Given the progress and achievements occurring in 2017, we have put together those major progresses as the “2017 Yearbook of Neurorestoratology”, which can help readers to easily follow the latest developments in Neurorestoratology.

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Clinical therapeutic guideline for neurorestoration in spinal cord injury (Chinese version 2016)

Cited by 13 publications

References 60 publications

A novel calcium phosphate–based nanocomposite for the augmentation of cement-injectable cannulated pedicle screws fixation: A cadaver and biomechanical study

A novel calcium phosphate–based nanocomposite for the augmentation of cement-injectable cannulated pedicle screws fixation: A cadaver and biomechanical study

Early durotomy with duroplasty for severe adult spinal cord injury without radiographic abnormality: a novel concept and method of surgical decompression

2017 Yearbook of Neurorestoratology

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