Continuous distraction-induced delayed spinal cord injury on motor-evoked potentials and histological changes of spinal cord in a porcine model

Hong, Jae Young; Suh, Seung Woo; Lee, S. H.; Park, J. H.; Park, S. Y.; Rhyu, Im Joo; Yang, Jae Hyuk

doi:10.1038/sc.2015.231

Cited by 18 publications

(8 citation statements)

References 33 publications

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“…Considering that the length of the same segment of a human is 90-100 mm 5) , this is equivalent to 18-20 mm in humans and is reported to be a safe zone for spinal surgery. In another group, SCI was reported in distractions of 20.2±4.7 mm, which corresponds to 3.6% of the TL junction length and 74.3% of the segmental vertebral height, in the global osteotomy of 3-column pig models 13,34) . Thus, in some animal experiments, the cutoff value for distraction SCI in humans can be approximated to about 20 mm, but it is not possible to directly compare animal cords to those of humans.…”

Section: Discussionmentioning

confidence: 97%

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Clinical Efficacy and Safety of Controlled Distraction-Compression Technique Using Expandable Titanium Cage in Correction of Posttraumatic Kyphosis

Kang

Lewis

Kim

2022

J Korean Neurosurg Soc

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Objective : To investigate the clinical efficacy and safety of the controlled distraction-compression technique using an expandable titanium cage (ETC) in posttraumatic kyphosis (PTK).Methods : We retrospectively studied and collected data on 20 patients with PTK. From January 2014 to December 2017, the controlled distraction-compression technique using ETC was consecutively performed in 20 patients with PTK of the thoracolumbar zone (range, 36–82 years). Among them, nine were males and 11 were females and the mean age was 61.5 years. The patients were followed regularly at 1, 3, 6, and 12 months, and the last follow-up was more than 2 years after surgery.Results : The mean follow-up period was 27.3±7.3 months (range, 14–48). The average operation time was 286.8±33.1 minutes (range, 225–365). The preoperative regional kyphotic angle (RKA) ranged from 35.6° to 70.6° with an average of 47.5°±8.1°. The immediate postoperative mean RKA was 5.9°±3.8° (86.2% correction rate, p=0.000), and at the last follow-up more than 2 years later, the mean RKA was 9.2°±4.9° (80.2% correction rate, p=0.000). The preoperative mean thoracolumbar kyphosis was 49.1°±9.2° and was corrected to an average of 8.8°±5.3° immediately after surgery (p=0.000). At the last follow-up, a correction of 11.9°±6.3° was obtained (p=0.000). The preoperative mean back visual analog scale (VAS) score was 7.9±0.8 and at the last follow-up, the VAS score was improved to a mean of 2.3±1.0 with a 70.9% correction rate (p=0.000). The preoperative mean Oswestry disability index (ODI) score was 32.3±6.9 (64.6%) and the last follow-up ODI score was improved to a mean of 6.85±2.9 (3.7%) with a 78.8% correction rate (p=0.000). The overall complication was 15%, with two of distal junctional fractures and one of proximal junctional kyphosis and screw loosening. However, there were no complications directly related to the operation.Conclusion : PVCR through the controlled distraction-compression technique using ETC showed safe and good results in terms of complications, and clinical and radiologic outcomes in PTK. However, to further evaluate the efficacy of this surgical procedure, more patients need long-term follow-up and there is a need to apply it to other diseases.

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Section: Discussionmentioning

confidence: 97%

“…SCI is known to occur not only by cord shortening but also by distraction and has been reported in adolescent idiopathic scoliosis surgery and distraction SCI animal models 5,13,32,34) . Wu et al 32) reported that no SCI occurred when distracted between L1 and L3 segments by 20% in experiments including 32 rabbits.…”

Section: Discussionmentioning

confidence: 99%

Clinical Efficacy and Safety of Controlled Distraction-Compression Technique Using Expandable Titanium Cage in Correction of Posttraumatic Kyphosis

Kang

Lewis

Kim

2022

J Korean Neurosurg Soc

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“…Several types of SCI have been experimented in pigs and may be categorized as follows: (1) compression injuries using clips (38–40) or computer-controlled stepping motor (41), (2) ischemic injuries with aortic cross or segmental artery occlusion (42–44), (3) root avulsion with ventral myelotomy (45), (4) vertebral column distraction/retraction (46–48), (5) spinal cord transection/hemisection (49–51), (6) spinal cord contusion using the controlled cortical impactor (29, 37, 52) or a weight-drop impactor (18–23). Despite these studies, there are no commercially available devices adapted to the size and the strength required for a 20–50 kg animal.…”

Section: Discussionmentioning

confidence: 99%

Development of a Multimodal Apparatus to Generate Biomechanically Reproducible Spinal Cord Injuries in Large Animals

et al. 2019

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Rodents are widespread animal models in spinal cord injury (SCI) research. They have contributed to obtaining important information. However, some treatments only tested in rodents did not prove efficient in clinical trials. This is probably a result of significant differences in the physiology, anatomy, and complexity between humans and rodents. To bridge this gap in a better way, a few research groups use pig models for SCI. Here we report the development of an apparatus to perform biomechanically reproducible SCI in large animals, including pigs. We present the iterative process of engineering, starting with a weight-drop system to ultimately produce a spring-load impactor. This device allows a graded combination of a contusion and a compression injury. We further engineered a device to entrap the spinal cord and prevent it from escaping at the moment of the impact. In addition, it provides identical resistance around the cord, thereby, optimizing the inter-animal reproducibility. We also present other tools to straighten the vertebral column and to ease the surgery. Sensors mounted on the impactor provide information to assess the inter-animal reproducibility of the impacts. Further evaluation of the injury strength using neurophysiological recordings, MRI scans, and histology shows consistency between impacts. We conclude that this apparatus provides biomechanically reproducible spinal cord injuries in pigs.

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“…In an experimental porcine study, Hong et al 8 demonstrated that continuous spinal distraction of 20 mm for 10 minutes induces spinal cord injury. Qiu et al 17 reported that the safe limit of distraction was 11.8 ± 3.65 mm in a goat model.…”

Section: Fig 4 a And Bmentioning

confidence: 99%

Delayed neurological deterioration following atlantoaxial facet joint distraction and fixation in a patient with Chiari malformation type I

Inoue

Hattori

Ganaha

et al. 2018

Journal of Neurosurgery: Spine

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Chiari malformation type I (CM-I) is typically treated with foramen magnum decompression. However, a recent study proposed a new technique for patients with CM-I, wherein only short atlantoaxial joint fusion and distraction is applied. Posterior fusion with or without atlantoaxial distraction is a potential option for patients with CM-I associated with basilar invagination or complex anomalous bony craniovertebral junction pathology, since this procedure allows clinicians to avoid using the technically demanding transoral approach in which some or all of the odontoid tip is invisible. Distraction of the atlantoaxial joint reduces ventral cervicomedullary compression, leading to neurological improvement. Here, the authors report the case of a 50-year-old woman with CM-I plus basilar invagination whose condition immediately improved but then gradually deteriorated following atlantoaxial joint distraction and fusion. Therefore, the authors performed endonasal/transoral odontoidectomy, which resulted in prolonged neurological recovery. Short atlantoaxial fusion with distraction is a smart and ideal surgical planning concept that can result in significant neurological improvement. However, this case suggests that anterior odontoidectomy is still an essential element of the intervention strategy for patients with CM-I with complex craniovertebral junction pathology.

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Continuous distraction-induced delayed spinal cord injury on motor-evoked potentials and histological changes of spinal cord in a porcine model

Abstract: Late onset injury due to continuous spinal distraction, which is comparable to iatrogenic SCI in spinal correction surgery, is important for understanding the impact of corrective surgery.

Cited by 18 publications

References 33 publications

Clinical Efficacy and Safety of Controlled Distraction-Compression Technique Using Expandable Titanium Cage in Correction of Posttraumatic Kyphosis

Clinical Efficacy and Safety of Controlled Distraction-Compression Technique Using Expandable Titanium Cage in Correction of Posttraumatic Kyphosis

Development of a Multimodal Apparatus to Generate Biomechanically Reproducible Spinal Cord Injuries in Large Animals

Delayed neurological deterioration following atlantoaxial facet joint distraction and fixation in a patient with Chiari malformation type I

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