Although methylprednisolone (MP) is the standard of care in acute spinal cord injury (SCI), its functional outcome varies in clinical situation. Recent report demonstrated that MP depresses the expression of growth-promoting neurotrophic factors after acute SCI. The present study was designed to investigate whether continuous infusion of brain-derived neurotrophic factor (BDNF) after MP treatment promotes functional recovery in severe SCI. Contusion injury was produced at the T10 vertebral level of the spinal cord in adult rats. The rats received MP intravenously immediately after the injury and BDNF was infused intrathecally using an osmotic mini-pump for six weeks. Immunohistochemical methods were used to detect ED-1, Growth associated protein-43 (GAP-43), neurofilament (NF), and choline acethyl transferase (ChAT) levels. BDNF did not alter the effect of MP on hematogenous inflammatory cellular infiltration. MP treatment with BDNF infusion resulted in greater axonal survival and regeneration compared to MP treatment alone, as indicated by increases in NF and GAP-43 gene expression. Adjunctive BDNF infusion resulted in better locomotor test scores using the Basso-Beattie-Bresnahan (BBB) test. This study demonstrated that continuous infusion of BDNF after initial MP treatment improved functional recovery after severe spinal cord injury without dampening the acute effect of MP.
Animals ; Anti-Inflammatory Agents/pharmacology ; Axons/pathology ; Brain-Derived Neurotrophic Factor/metabolism/*pharmacology ; Choline O-Acetyltransferase/metabolism ; Female ; GAP-43 Protein/metabolism ; Gene Expression Regulation ; Immunohistochemistry ; Methylprednisolone/metabolism/*pharmacology ; Osmosis ; Rats ; Rats, Sprague-Dawley ; Reverse Transcriptase Polymerase Chain Reaction ; Spinal Cord/pathology ; Spinal Cord Injuries/*pathology ; Time Factors

OBJECTIVE: The aims of this study were to present the newly developed pedicle guidance system for minimally invasive pedicle screw fixation under endoscopic visualization and to evaluate the feasibility, safety, and efficacy of this device. METHODS: The authors designed a special guidance device that allows a pedicle screw to be inserted with ease and accuracy under endoscopic visualization. The system consists of a bone biopsy needle (Jamshidi type needle), fiducial pins, a pushing trocar, retriever, specialized awls, and probes. After making an inch-long paramedian skin incision, the bone biopsy needle was percutaneously inserted into the pedicle, as in vertebroplasty, and the fiducial pin was inserted through the needle after removing the inner cannula. The fiducial pin was advanced into the vertebral body until the threaded distal end was positioned 1-2 cm away from the posterior bony structure. The biopsy needle was removed, leaving the fiducial pin in position. The operative wound was then dilated with a step dilator, a tubular retractor was introduced, and an endoscope was placed. Decompressive laminectomy and interbody fusion were then performed. A tubular retractor was repositioned in order to visualize the fiducial pins. A cannulated awl was used to create a hole over the fiducial pin. The pedicle trajectory was prepared using a cannulated probe, and a pedicle screw was inserted under fluoroscopic and endoscopic guidance. RESULT: Fifteen patients underwent surgery using this method. In all cases, the screws were safely inserted without misplacement. The overall operative time ranged from 180 min to 260 min (mean 219.3 min). There were no procedure related complications. CONCLUSION: This newly designed device proved to be practical, time saving, and useful for endoscope-assisted pedicle screw fixation.
Biopsy ; Catheters ; Endoscopes ; Endoscopy ; Humans ; Laminectomy ; Lumbar Vertebrae ; Needles ; Operative Time ; Skin ; Spinal Fusion ; Surgical Instruments ; Vertebroplasty

No abstract available.
Neuroendocrine Tumors