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Study Design. A questionnaire survey. Objective. To characterize surgeons' current perspectives on the administration of methylprednisolone for acute spinal cord injury (SCI) and determine how this has changed during the last 7 years. Summary of Background Data. The determinants of and complications associated with off-label steroid use for acute SCI remain controversial. Methods. A survey was sent to surgeon members of the Cervical Spine Research Society requesting information regarding their use of steroids for acute SCI. Determinants included surgeons' specialty, trauma center level, number of SCIs treated per year, severity of injury, and location of injury. These results were compared across groups as well as with a historical control. Results. In the case of cervical complete and incomplete SCIs, 47.4% and 56.4% of respondents, respectively, reported using steroids. For complete and incomplete thoracolumbar spine injuries, the usage rate was 46.2% and 55.1%, respectively. There has been a significant (P < 0.0001) decrease in the number of surgeons using high-dose steroids in the treatment of acute SCIs when compared with a previous report in 2006 (56% vs. 89%). More than 80% of respondents reported sepsis, active gastrointestinal bleeding, and SCI occurring earlier than 8 hours as contraindications. Seventy-one percent of respondents reported observing complications from the use of steroids, and 76.3% thought that the complications were severe enough to limit steroid use. Of the surgeons who used steroids for SCI, 26% thought that steroids improved neurological recovery, 19.2% used steroids to adhere to institutional protocol, and 25.6% stated they did not think steroids were beneficial but used them because of medicolegal concerns. Conclusion. There has been a significant decrease in the number of surgeons using high-dose steroids for acute SCIs. Sepsis, gastrointestinal bleeding, and an injury occurring more than 8 hours prior to presentation were agreed upon as contraindications to steroid use. [ABSTRACT FROM AUTHOR]

The article discusses a research study that aimed to provide an overview of the neurobiologic challenges of spinal cord injury (SCI). Scientific and clinical research activity has provided insight into the neurobiology of SCI and has generated potential therapies. A review of published data on novel treatments for human clinical trials for acute SCI was made. The researchers recognized the importance of clinical evaluation in determining the actual efficacy of treatments in SCI.

The article reports on the results of a study to determine if viral vectors carrying the gene for brain-derived neurotrophic factor (BDNF) could be used to promote an axonal regenerative response in rubrospinal neurons after an acute cervical spinal cord injury. A description of the experimental set-up and measurement method is presented. The study concluded that viral-mediated transfer of the BDNF gene was successful at promoting a regenerative response in rubrospinal neurons.

Study Design: A biomechanical study addressing the motion of pedicle screws in a human cadaveric, osteoporotic spine model.Objectives: To compare the fixation of pedicle screws in an osteoporotic spine model after augmentation with laminar hooks, sublaminar wires, or calcium phosphate cement and to determine the kinematic patterns of these screws.Summary Of Background Data: Numerous techniques exist for improving the quality of fixation within the osteoporotic spine, including supplementing the construct with laminar hooks, sublaminar wires, or calcium phosphate cement. Direct comparisons of these practices, however, are lacking. METHODS.: Twenty-four cadaveric lumbar vertebrae were instrumented with a pedicle screw and rod construct augmented with laminar hooks, sublaminar wires, or calcium phosphate cement. The screws were tested cyclically with physiologic loads. Rigid body motions of the screws were measured using an optoelectronic camera system, and the motion at the screw tip and at the screw head were calculated. Screw motions were compared using nonparametric paired statistical analysis.Results: Between augmentation groups, there were no significant differences in the magnitude of motion at the screw head and at the screw tip. After calcium phosphate cement supplementation, screw motion was predominantly rotational in nature, whereas rigid body translation of the screw was more common with sublaminar wires or laminar hooks.Conclusions: The three augmentation techniques were similar in their ability to enhance the rigidity of fixation of the pedicle screws. Differences did exist, however, in the patterns of pedicle screw motion, with the calcium phosphate cement augmentation resulting in less rigid body translation than the other two techniques. [ABSTRACT FROM AUTHOR]