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Abstract Background Neurocysticercosis is a parasitic infection of the central nervous system by tapeworm larvae. Spinal cysticercosis is thought to be relatively rare, and spinal nerve root sleeve cysticercosis have not been reported previously. Case presentation A 46-year-old Chinese Han female patient presented with low back pain and radicular pain of the right lower limb. The visual analog scale was 6. Magnetic resonance imaging showed a subarachnoid cyst at the S1 level, with a slight enhanced rim. The patient underwent surgical treatment. During surgery, we found the cyst located mainly in the subarachnoid space and partly in a sacral nerve root sleeve. Cysticercosis was also confirmed by postoperative pathological examination. Postoperative drug therapy was performed after cysticercosis was confirmed. Postoperatively, the patient was treated with oral albendazole (15 mg/kg) for 1 month. Only mild sensory impairment was left when she was discharged. After 3 years of follow-up, the visual analog scale reduced from 6 to 2, and the patient’s sensory function completely recovered. Magnetic resonance imaging showed no recurrence of cysticercosis. Conclusion Subarachnoid cysticercosis may extend to nerve root sleeve causing back pain and radiculopathy, which may present with similar magnetic resonance imaging manifestations to Tarlov cysts. Hence, spinal subarachnoid cysticercosis should be considered as an important differential diagnosis of arachnoid cyst and sacral Tarlov cyst. Combined treatment with surgical removal and drug therapy is effective to manage spinal subarachnoid cysticercosis.

Bone metastases frequently occur in patients with cancer. Skeletal-related events (SREs), including pain, impaired mobility, hypercalcemia, pathological fracture, spinal cord and nerve root compression, and bone marrow infiltration, can decrease the quality of life of the patients and increase the risk of morbidity. The mechanism of pain due to bone metastasis is complicated and involves various interactions among tumor cells, bone cells, activated inflammatory cells, and bone-innervating neurons. Cancer pain due to bone metastasis can be crippling and a chronic state that causes sarcopenia. For pain management, it is important to diagnose whether the pain is based on background pain or breakthrough pain due to bone metastasis. In addition, the management goal of cancer pain due to bone metastasis is not only to achieve pain relief but also to prevent pain progression and SREs. Pain mechanisms should be applied to achieve optimal management. This review aims to discuss the mechanisms of cancer pain due to bone metastasis and review the recommended drug therapies. [ABSTRACT FROM AUTHOR]

Chronic, often intractable, pain is caused by neuropathic conditions such as traumatic peripheral nerve injury (PNI) and spinal cord injury (SCI). These conditions are associated with alterations in gene and protein expression correlated with functional changes in somatosensory neurons having cell bodies in dorsal root ganglia (DRGs). Most studies of DRG transcriptional alterations have utilized PNI models where axotomy-induced changes important for neural regeneration may overshadow changes that drive neuropathic pain. Both PNI and SCI produce DRG neuron hyperexcitability linked to pain, but contusive SCI produces little peripheral axotomy or peripheral nerve inflammation. Thus, comparison of transcriptional signatures of DRGs across PNI and SCI models may highlight pain-associated transcriptional alterations in sensory ganglia that do not depend on peripheral axotomy or associated effects such as peripheral Wallerian degeneration. Data from our rat thoracic SCI experiments were combined with meta-analysis of published whole-DRG RNA-seq datasets from prominent rat PNI models. Striking differences were found between transcriptional responses to PNI and SCI, especially in regeneration-associated genes (RAGs) and long noncoding RNAs (lncRNAs). Many transcriptomic changes after SCI also were found after corresponding sham surgery, indicating they were caused by injury to surrounding tissue, including bone and muscle, rather than to the spinal cord itself. Another unexpected finding was of few transcriptomic similarities between rat neuropathic pain models and the only reported transcriptional analysis of human DRGs linked to neuropathic pain. These findings show that DRGs exhibit complex transcriptional responses to central and peripheral neural injury and associated tissue damage. Although only a few genes in DRG cells exhibited similar changes in expression across all the painful conditions examined here, these genes may represent a core set whose transcription in various DRG cell types is sensitive to significant bodily injury, and which may play a fundamental role in promoting neuropathic pain. [ABSTRACT FROM AUTHOR]

Lumbar radicular pain also known as sciatica in the past, is a very common condition with high impact on patients' lives, its precise definition is not clearly understood, radicular pain definition is based on its mechanism as pain evoked by stimulation of the sensory (dorsal) root of a spinal nerve or its dorsal root ganglion (DRG). The morphological pattern of the herniated disc plays an important role in LRP and is correlated strongly with the clinical picture, prognosis, and suitable treatment strategy. Chronic radicular pain is not merely an extension of the acute phase. However, local, spinal and supraspinal mechanisms interplay in the development of chronic pain. Mechanical events, particularly abnormal motion or loads to neural tissues, may trigger the mechanisms of chronic pain. Local axonal injury in particular has been shown to increase excitability and spontaneous activity of the DRG neurons. Steroids have been demonstrated to have a therapeutic role, owing to their anti-inflammatory and nociceptive signal stabilising properties. Selective nerve root injection (SNRI) or trans-foraminal epidural steroid injection (TFESI) is a technique that enables precise delivery of corticosteroid and local anesthetic in close proximity to nerve root under radiological guidance, thereby optimising the therapeutic effect. With the ultrasound growing popularity as a useful diagnostic tool and as a guiding tool in lumbar spine procedures, it has been suggested that ultrasound can aid in reducing the use of fluoroscopy or replace it completely in performing selective lumbar nerve root injection. [ABSTRACT FROM AUTHOR]

Background: The role of stimulation parameters, especially stimulation frequency is not well understood in dorsal root ganglion stimulation. Previous studies documented higher effectiveness for frequencies as low as 20 Hz, but there is evidence that even lower values could lead to better outcomes. In this study, we investigate the influence of low-frequency DRG-S. Method: This is a randomized double-blind clinical trial with a crossover design. Patients with an already implanted DRG-S system were included and randomly tested with 4 Hz, 20 Hz, 60 Hz, and sham stimulation. Amplitude was adjusted to subthreshold values for each frequency. Each frequency was tested for 5 days, followed by a 2-day washout period. Patients were assessed using VAS, McGill Pain Questionnaire, EQ-5D-5L, and Beck Depression Inventory. Results: Seventeen patients were in included. Time between inclusion in this study and primary implant was 32.8 months. Baseline stimulation frequency was 20 Hz in all patients. Mean baseline pain intensity was VAS 3.2 (SD 2.2). With 4-Hz stimulation, VAS was 3.8 (SD 1.9), with 20 Hz VAS 4.2 (SD 2.0) and with 60 Hz VAS 4.6 (SD 2.7). Worst pain control was seen with sham stimulation with a VAS of 5.3 (SD 3.0). Stimulation with 4 Hz achieved lower VAS scores, but this was only statistically significant when compared to sham (p = 0.001). A similar trend favoring 4-Hz stimulation was seen using the Beck Depression Inventory, but in this case no statistical significance was found. Outcomes of McGill Pain Questionnaire and EQ-5D-5L favored 20 Hz stimulation, but again without statistical significance. Conclusions: Low-frequency stimulation was not significantly better than classic 20-Hz stimulation in relieving pain intensity; the study might however be underpowered. Longer washout and observational periods might also be necessary to show clear differences in frequency response. [ABSTRACT FROM AUTHOR]

Background. This case report highlights the importance of accurate diagnosis and treatment for intramedullary spinal cord hemangioma, which is a rare condition that can present with common symptoms of various spinal cord pathologies. The report recommends decompression laminectomy as the appropriate intervention for this condition. This report adds to the existing clinical literature on intramedullary spinal cord hemangioma and can assist clinicians in the diagnosis and treatment of similar cases. Case report. The patient is a 30-year-old female who complained of left leg heaviness, cramps, numbness, and urinary incontinence. MRI revealed a suspected intradural intramedullary lesion, as high as VTh5, suspected to be ependymoma or astrocytoma. The patient underwent decompressive laminectomy on thoracalis vertebra 5-7 and spinal cord mass with hemorrhage and calcification components was observed on post-operative Spinal CT Angiography. The mass was found to have a feeder artery from spinal branches of the left right a. intercostalis at T5 level and spinal branches of the left a. intercostalis at T6 level. Thoracolumbar spondylosis was also observed. Conclusion. The clinical impact of vertebral hemangioma lies in its potential to cause neurological deficits due to spinal cord or nerve root compression. Early diagnosis and treatment through imaging modalities such as MRI and surgical intervention, such as laminectomy, can alleviate symptoms and prevent disability or mortality. However, careful consideration of the patient’s clinical history, imaging findings, and neurological status is necessary for accurate diagnosis and appropriate management. [ABSTRACT FROM AUTHOR]

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Background: Bilateral cervical facet dislocations present with severe neurological deficit and an unstable spine. Cervical dislocations with locked facets account for more than 50% of all cervical injuries. The rapid reduction should give the patient the best chance for neurological recovery from compression of the spinal cord or nerve root, or at least prevent progressive secondary spinal cord injury, however, the proper method for reduction and operation is still controversial. Purpose: To evaluate the surgical outcome in cervical spine injury with bilateral facet dislocation. Patients and Methods: In this study, all the records of sixteen patients with cervical bilateral facet dislocations were reviewed. The SLIC scoring was used for surgical decisions. These cases were managed in our department by open reduction and internal fixation from Jan 2018 to March 2020. Clinically we used the Frankel scale to evaluate our patients. Of our 16 patients, nine cases were managed by the anterior approach; four cases were managed by the posterior approach. And three cases needed a combined approach. Results: Mean age was 38 years. A road traffic accident was the cause of 80%. One patient had no neurological deficit. C5/6 and C 6/7 were the commonest injured segments (80%). Disc compression was present in 58% (eleven patients) of cases. The mean SLIC score was 8 and the mean hospital stay was 15 days. Restoring spinal alignment and reduction of facets was achieved in 87.5% (fourteen patients) of patients. Conclusion: Bilateral facet dislocation is a serious sequel to cervical spine trauma. It can present with the entire spectrum of neurological deficits. Patients with incomplete spinal cord injury show improvement after early decompression and fixation. [ABSTRACT FROM AUTHOR]

Background: Spinal epidermoid tumors are rare, comprising of less than 1% of tumors involving the spine. These tumors arise from pathological displacement of epidermal cells into the spinal canal. Therefore, these tumors can be congenital, when there is improper closure of the neural tube; or acquired, in patients who have had prior lumbar punctures, trauma, or surgery. Spinal epidermoids are typically found in the lumbosacral region but can be found in other locations as well. Case presentation: We report an original case of a 50 year old. He presented with 1 year with back pain and bilateral sciatica. The patient was neurological intact with no sphincter incompetence. The magnetic resonance image of the lumbosacral spine showed a 12 × 3 cm well-circumscribed intradural mass at the L3–S1 level. The patient was operated on with posterior lumbar laminectomy for tumor removal. Postoperation, the patient had improved pain and numbness. The motor power was intact as preoperative. Conclusions: MRI with DWI is especially useful to confirm the diagnosis with the lesions appearing hyperintense. The most conventional approach to resection involved laminectomies and intradural tumor resection. GTR provided better outcomes in most cases even when the tumor was adherent to the nearby spinal cord or nerve roots. [ABSTRACT FROM AUTHOR]

Peripheral artery diseases (PAD) increases muscle afferent nerve‐activated reflex sympathetic nervous and blood pressure responses during exercise (termed as exercise pressor reflex). However, the precise signaling pathways leading to the exaggerated autonomic responses in PAD are undetermined. Considering that limb ischemia/reperfusion (I/R) is a feature of PAD, we determined the characteristics of acid‐sensing ion channel (ASIC) currents in muscle dorsal root ganglion (DRG) neurons under the conditions of hindlimb I/R and ischemia of PAD. In particular, we examined ASIC currents in two distinct subpopulations, isolectin B4‐positive, and B4‐negative (IB4+ and IB4−) muscle DRG neurons, linking to glial cell line‐derived neurotrophic factor and nerve growth factor. In results, ASIC1a‐ and ASIC3‐like currents were observed in IB4− muscle DRG neurons with a greater percentage of ASIC3‐like currents. Hindimb I/R and ischemia did not alter the distribution of ASIC1a and ASIC3 currents with activation of pH 6.7 in IB4+ and IB4− muscle DRG neurons; however, I/R altered the distribution of ASIC3 currents in IB4+ muscle DRG neurons with pH 5.5, but not in IB4− neurons. In addition, I/R and ischemia amplified the density of ASIC3‐like currents in IB4− muscle DRG neurons. Our results suggest that a selective subpopulation of muscle afferent nerves should be taken into consideration when ASIC signaling pathways are studied to determine the exercise pressor reflex in PAD. [ABSTRACT FROM AUTHOR]

Background: Spinal schwannomas (SSs) are benign tumors affecting the nerve sheath, accounting for 25% of spinal nerve root tumors. Surgery represents the mainstay of treatment for SS patients. Following surgery, approximately 30% of patients experienced developed new or worsening neurological deterioration, which probably represented an inevitable complication of nerve sheath tumor surgery. The objective of this study was to identify the rates of new or worsening neurological deterioration in our center and accurately predict the neurological outcomes of patients with SS by developing a new scoring model. Methods: A total of 203 patients were retrospectively enrolled at our center. Risk factors associated with postoperative neurological deterioration were identified by multivariate logistic regression analysis. b-coefficients for independent risk factors were used to define a numerical score to generate a scoring model. The validation cohort at our center was used to verify the accuracy and reliability of the scoring model. Receiver operating characteristic (ROC) curve analysis was used to evaluate the performance of the scoring model. Results: In this study, five measured variables were selected for the scoring model: duration of preoperative symptoms (1 point), radiating pain (2 points), tumor size (2 points), tumor site (1 point), and dumbbell tumor (1 point). The scoring model divided the spinal schwannoma patients into three categories: low risk (0-2 points), intermediate risk (3-5 points), and high risk (6-7 points), with predicted risks of neurological deterioration of 8.7%, 36%, and 87.5%, respectively. And the validation cohort confirmed the model with the predicted risks of 8.6%, 46.4%, and 66.6%, respectively. Conclusion: The new scoring model might intuitively and individually predict the risk of neurological deterioration and may aid individualized treatment decisionmaking for SS patients. [ABSTRACT FROM AUTHOR]

During nervous system development, neurons send out axons, which must navigate large distances to reach synaptic targets. Axons grow out sequentially. The early outgrowing axons, pioneers, must integrate information from various guidance cues in their environment to determine the correct direction of outgrowth. Later outgrowing follower axons can at least in part navigate by adhering to pioneer axons. In Caenorhabditis elegans, the right side of the largest longitudinal axon tract, the ventral nerve cord, is pioneered by the AVG axon. How the AVG axon navigates is only partially understood. In this study, we describe the role of two members of the IgCAM family, wrk-1 and rig-5, in AVG axon navigation. While wrk-1 and rig-5 single mutants do not show AVG navigation defects, both mutants have highly penetrant pioneer and follower navigation defects in a nid-1 mutant background. Both mutations increase the fraction of follower axons following the misguided pioneer axon. We found that wrk-1 and rig-5 act in different genetic pathways, suggesting that we identified two pioneer-independent guidance pathways used by follower axons. We assessed general locomotion, mechanosensory responsiveness, and habituation to determine whether axonal navigation defects impact nervous system function. In rig-5 nid-1 double mutants, we found no significant defects in free movement behavior; however, a subpopulation of animals shows minor changes in response duration habituation after mechanosensory stimulation. These results suggest that guidance defects of axons in the motor circuit do not necessarily lead to major movement or behavioral defects but impact more complex behavioral modulation. [ABSTRACT FROM AUTHOR]

Introduction: Complex regional pain syndrome (CRPS) is characterized by nociplastic pain with alterations in sympathetic function. Neuromodulation could be a useful alternative therapy option. Dorsal root ganglion (DRG) stimulation has demonstrated better results than conventional spinal cord stimulation (SCS) for patients with CRPS in lower limbs. Methods: We report a case series of seven patients treated with cervical DRG stimulation for CRPS of the hand that required neuromodulation for pain relief, after no response with other analgesic techniques (medication and interventional). We report retrospective data collection of seven consecutive patients with a 1‐year follow‐up. Results: Seven patients were trialed, and six were implanted with a permanent pulse generator after achieving more than 50% pain relief during 2–7 days of trial phase. The average pain relief (rated on a standard 100 mm visual analog scale) after 1 year of treatment was 64.3% ± 16.6. No major complications were observed during a 1‐year follow‐up. Discussion: The results for cervical DRG stimulation are similar to other DRG stimulation studies for the treatment of refractory CRPS at lower levels. The cervical DRG implant technique guided with C‐arm fluoroscopy and under conscious sedation could be a safe and effective option for relieving pain of the upper limbs CRPS. Monitoring neural status is required for cervical DRG stimulation either with a responder awake patient or with intraoperative neural monitoring in non‐responder patients. [ABSTRACT FROM AUTHOR]

Kaurenoic acid (KA) is a diterpene extracted from Sphagneticola trilobata (L.) Pruski. KA presents analgesic properties. However, the analgesic activity and mechanisms of action of KA in neuropathic pain have not been investigated so far; thus, we addressed these points in the present study. A mouse model of neuropathic pain was induced by chronic constriction injury (CCI) of the sciatic nerve. Acute (at the 7th-day post-CCI surgery) and prolonged (from 7–14th days post-CCI surgery) KA post-treatment inhibited CCI-induced mechanical hyperalgesia at all evaluated time points, as per the electronic version of von Frey filaments. The underlying mechanism of KA was dependent on activating the NO/cGMP/PKG/ATP-sensitive potassium channel signaling pathway since L-NAME, ODQ, KT5823, and glibenclamide abolished KA analgesia. KA reduced the activation of primary afferent sensory neurons, as observed by a reduction in CCI-triggered colocalization of pNF-κB and NeuN in DRG neurons. KA treatment also increased the expression of neuronal nitric oxide synthase (nNOS) at the protein level as well as the intracellular levels of NO in DRG neurons. Therefore, our results provide evidence that KA inhibits CCI neuropathic pain by activating a neuronal analgesic mechanism that depends on nNOS production of NO to silence the nociceptive signaling that generates analgesia. [ABSTRACT FROM AUTHOR]

Background Trigeminal neuralgia is considered the worst pain a human being can experience. Initial treatment uses anticonvulsant sodium channel blockers, which relieve pain in approximately 70% of patients. In refractory cases, it is possible to perform ablative treatments, decompressive surgeries, and neuromodulatory techniques. Methods This report describes the treatment of a patient with refractory trigeminal neuralgia who continued to have a painful clinical presentation after four surgical procedures and three ablative procedures. The patient presented with severe pain (verbal numerical scale between 9 and 10), manifesting an evident suicidal ideation. A dorsal root ganglion (DRG) stimulation electrode was implanted in the trigeminal ganglion through intraoral puncture with maxillary fixation of the electrode, in order to minimize the chances of displacement. The test phase consisted of implanting a quadripolar electrode for DRG stimulation through puncture lateral to the buccal rim in a fluoroscopic coaxial view. The electrode was fixed to the skin and maintained for 5 days, during which the patient remained completely pain free. After the 5-day test period, the definitive stimulation electrode was implanted, this time with intraoral puncture and maxillary electrode fixation. Results The patient remains pain free in the 3-month follow-up, with no displacement of the electrode. Conclusions The DRG electrode may be considered a therapeutic option in patients with severe trigeminal neuralgia. Controlled studies must be performed to determine the efficacy and safety of the method. [ABSTRACT FROM AUTHOR]

The incidence of spinal cord (SC) injury in developed and undeveloped countries is alarming. The pig (Sus scrofa) has been recommended as a suitable research model for translational studies because of its morphophysiological similarities of organ systems with humans. There is a dearth of information on the SC anatomy of the large white and landrace crossbreed (LW‐LC) pigs. We therefore aim to describe the gross morphology and morphometry of its SC. Twelve juvenile LW‐LC pigs (six males and six females) were used. The skin and epaxial muscles were dissected to expose the vertebral column. The SC was carefully harvested by laminectomy, and 13 gross SC morphometric parameters were evaluated. Thirty‐three spinal nerves were seen emanating from either side of the SC by means of dorsal and ventral spinal roots. The overall average of SC length and weight was 36.23 ± 1.01 cm and 16.60 ± 0.58 g, respectively. However, the mean SC length and weight were higher in females compared with males, with SC weight being statistically significant. A positive relationship between SC length and weight was significant for males (p = 0.0435) but not for females (p = 0.42). Likewise, the strength of the relationship between SC length and weight was significant in males (r = 0.82) but not significant in females (r = 0.41). Baseline data for the morphometric features of the spinal cord in the LW‐LC pigs were generated, which will contribute to the knowledge of this species anatomy and useful information on regional anaesthesia that should further strengthen the drive in adopting the pig as a suitable research model for biomedical research. [ABSTRACT FROM AUTHOR]

Introduction: Myelomeningocele (MMC) is a malformation resulting from the neural tube's failure to close during embryonic development, and the majority of the cases of neural tube defects (NTDs) were prevalent as single location lesions along the spine; however, multiple NTDs (MNTDs) are a very rare condition. Only a few cases of MNTDs were found in the literature. Case Presentation: We report the case of a 2-month-old male infant prenatally diagnosed with MMC, presented with two unconnected lumbar and lumbosacral epidermal, soft, dome-shaped swellings located on both sides of the midline (paravertebral) covered by intact skin. MRI revealed double MMC at the level of L4-L5, with spinal nerve roots. The patient underwent surgical repair of the defects by replacing the spinal cord and its nerve roots inside the thecal sac and recreating a covering layer around the neural structures to resemble thecal sac. The outcome was favorable, and postoperative head CT scan did not show any complication. Conclusion: Our case report is considered the first from Algeria to report the condition and the first to report the occurrence of double lesions in the same spine region. MMC can be associated with neurological deficits or other congenital anomalies, thus it is necessary to thoroughly examine such patients. However, there was no antenatal folic acid deficiency in our case. We recommend antenatal care with adequate folic acid supplementation given that its deficiency during pregnancy is considered a ubiquitous risk factor for the condition. The optimal timing for surgery of MMC cases is 8 ± 5 days. Prenatal intrauterine repair of the condition provides favorable outcomes but carries high fetal and maternal risks. Surgical repair should include the sac removal, the reconstruction of the placode, and the closure of the overlying meninges. With early diagnosis and proper repair of such cases, MMC has good prognosis and favorable outcomes. [ABSTRACT FROM AUTHOR]

Background Spinal stenosis is a neurological disorder related to the compression of the spinal cord or nerve roots, and its incidence increases yearly. We aimed to use Mendelian randomization (MR) to investigate the causal relationship between several modifiable risk factors and the risk of spinal stenosis. Methods We obtained genome-wide association study summary data of large-sample projects (more than 100,000 individuals) from public databases. The data were associated with traits, including years of schooling (educational attainment) from the IEU OpenGWAS Project, smoking behavior (never vs. initiation) from the IEU OpenGWAS Project, body mass index (BMI) from the UK Biobank, length of mobile phone use from the UK Biobank, time spent watching television (TV) from the UK Biobank, and spinal stenosis from FinnGen biobank. Spinal stenosis was used as the outcome, whereas the other four traits were used as exposures. Inverse variance weighted (IVW) regressions were used as a primary to estimate the causal-effect size. Several sensitive analyses (including consistency, heterogenicity, and pleiotropy analyses) were conducted to test the stability and reliability of causal estimates. Results Univariable MR analyses showed that genetically predicted higher educational attainment (IVW; odds ratio (OR) = 0.606; 95% confidence interval (CI): 0.507–0.724; P = 3.37 × 10−8) and never smoking (IVW; OR = 1.388; 95% CI [1.135–1.697]; P = 0.001) were negatively correlated with the risk of spinal stenosis. Meanwhile, a higher BMI (IVW; OR = 1.569; 95% CI [1.403–1.754]; P = 2.35 × 10−8), longer time spent using a mobile phone (IVW; OR = 1.895; 95% CI [1.306–2.750]; P = 0.001), and watching TV (IVW; OR = 1.776; 95% CI [1.245–2.532]; P = 0.002) were positively associated with the risk of spinal stenosis. Multivariable MR analysis indicated that educational attainment (IVW; OR = 0.670; 95% CI [0.465–0.967]; P = 0.032) and BMI (IVW; OR = 1.365; 95% CI [1.179–1.580]; P = 3.12 × 10−5) were independently causally related to the risk of spinal stenosis. Conclusion Our findings supported the potential causal associations of the five factors (educational attainment, smoking behavior, BMI, length of mobile phone use, and watching TV) with the risk for spinal stenosis. While replication studies are essential, these findings may provide a new perspective on prevention and intervention strategies directed toward spinal stenosis. [ABSTRACT FROM AUTHOR]

With continued innovations in neuromodulation comes the need for evolving reviews of best practices. Dorsal root ganglion stimulation (DRG-S) has significantly improved the treatment of complex regional pain syndrome (CRPS), and it has broad applicability across a wide range of other conditions. Through funding and organizational leadership by the American Society for Pain and Neuroscience (ASPN), this best practices consensus document has been developed for the selection, implantation, and use of DRG stimulation for the treatment of chronic pain syndromes. This document is composed of a comprehensive narrative literature review that has been performed regarding the role of the DRG in chronic pain and the clinical evidence for DRG-S as a treatment for multiple pain etiologies. Best practice recommendations encompass safety management, implantation techniques, and mitigation of the potential complications reported in the literature. Looking to the future of neuromodulation, DRG-S holds promise as a robust intervention for otherwise intractable pain. [ABSTRACT FROM AUTHOR]

Intraneural hemangiomas are rare benign neoplasms. We report the case of a 53‑year‑old female with a hemangioma in a spinal nerve root. The patient presented with muscular atropy of the right arm wihout obvious predisposing factors one year ago. MRI demonstrated a heterogeneously enhanced lesion adjacent to the right C4/5 intervertebral foramen. The lesion was considered to be a schwannoma preoperatively. Histologically, the lesion was abundant with intervening malformed vascular mass lined by simple squamous epithelial cells, and CD31 was positively stained at these epithelial cells by immunohistochemistry. The patient underwent microsurgical resection and recovered without complications. [ABSTRACT FROM AUTHOR]

This article discusses a rare complication of shunt drainage called Miyazaki Syndrome. The syndrome arises from excessive drainage of cerebrospinal fluid (CSF) through ventriculoperitoneal (VP) shunts, leading to CSF hypotension and cervical epidural venous congestion. Symptoms include myelopathy and radiculopathy, and the syndrome can manifest without the typical symptom of orthostatic headache. Timely recognition and diagnostic imaging are crucial for diagnosis, and treatment involves addressing CSF over-drainage through interventions such as adjusting the valve system or removing the shunt. This case highlights the importance of understanding and diagnosing Miyazaki Syndrome to improve patient outcomes. [Extracted from the article]

Spinal arteriovenous fistulas (AVFs) account for approximately 70% of all vascular spinal malformations and commonly develop in the lateral epidural space at the epidural /radicular venous junction. The fistula is located close to the spinal nerve root where a radiculomeningeal artery shunts to a radicular vein. Increased venous pressure leads to decreased spinal venous drainage and venous congestion causing progressive myelopathy, bowel/bladder incontinence and erectile dysfunction. Treatment consists of surgical occlusion of the intradural vein, or endovascular embolization, which has a reported success rate of 25%−75%. 1 Endovascular failure can occur with inadequate embolic penetration of the nidus and the proximal segment of the draining vein, or premature reflux of the liquid embolic agent. The use of a dual-lumen balloon microcatheter offers advantage in these cases given the ability to push liquid embolysate more distally during balloon inflation. The Scepter Mini is a new dimethyl-sulfoxide (DMSO)-compatible dual-lumen balloon microcatheter with a distal-tip outer diameter of 1.6 Fr and a nominal balloon diameter of 2.2 mm, facilitating atraumatic navigation and safer balloon inflation. Limited neurointerventional experience using the Scepter Mini in predominantly cerebrovascular cases has reported favorable navigability and flow arrest 2 , 3 Although Onyx is rarely used for spinal AVF embolization, success has been reported considering the well-known favorable experience in cerebral cases. 1 , 4 , 5 We present one of the first cases of Onyx embolization of a spinal dural AVF through a Scepter Mini in a patient with progressively worsening lower extremity sensorimotor dysfunction. Operators should be aware of radiculomedullary arteries arising at the same level or at adjacent levels to avoid unintentional Onyx migration during balloon inflation. [ABSTRACT FROM AUTHOR]

Introduction: Delayed orgasm may be considered an unwanted, atypically long latency during most genital/sexual activity despite sexual stimulation, causing significant distress to the individual and/or partner, persisting for at least 6 months. Delayed orgasm is reported to affect 6.9% of women. It is associated with negative effects on sexual function, sexual satisfaction, and relationship satisfaction. Pharmacologic, endocrinologic, and neurobiological pathophysiological factors have been identified as possible etiologies of delayed orgasm, but an under-researched etiology is lumbosacral disc disease, specifically lumbosacral annular tear-induced sacral radiculopathy. The pelvic, pudendal, and sciatic nerves all merge at the S2-4 foramina where they coalesce to form the S2-4 nerve roots. These sacral spinal nerve roots (S2-4) ascend to the first synapse in the conus medullaris. During their ascent, they can be irritated mechanically by impingement/compression or chemically by exposure to the extruded nucleus pulposus from lumbosacral annular tears, and thereby disrupt genital sensory transmission with resultant delayed orgasm. The new evidence that delayed orgasm can be successfully treated by endoscopic spine surgery supports the association of delayed orgasm with sacral radiculopathy. There is still a paucity of research regarding delayed orgasm from lumbosacral disc disease. Objective: To review the existing literature concerning the contribution of lumbosacral disc disease to delayed orgasm. Methods: A literature search on delayed orgasm, its impacts and possible etiologies was performed. The following keywords were searched on Pubmed individually and in combination, related to the association between delayed orgasm and lumbosacral disc disease: delayed orgasm, delayed ejaculation, sexual dysfunction, anorgasmia, and persistent genital arousal disorder. Current definitions were compiled, and overall epidemiology, anatomy, and biopsychosocial factors of delayed orgasm were explored. Results: There are a number of publications (n = 19) demonstrating the development of sexual dysfunction after damage to the sacral spinal nerve roots. Furthermore, several studies (n = 4) and case reports (n = 1) have demonstrated that treating lumbosacral disc disease reduces sexual dysfunction including improvement in delayed or reduced ejaculation. While delayed ejaculation encompasses the experience of delayed orgasm for some individuals, the literature fails to address delayed orgasm comprehensively in relation to lumbosacral disc disease, and thus fails to address treatment of lumbosacral disc disease and subsequent resolution of delayed orgasm. People with vulvas are particularly underrepresented in the literature studying the connection between lumbosacral disc disease and delayed orgasm. Conclusions: While lumbosacral disc disease has many side effects that may impede daily function, sexual side effects can further detract from one's personal life and relationship satisfaction. Thus, improving clinician awareness of sexual side effects, particularly delayed orgasm, can help improve treatment for individuals especially as they age. Further research is needed to strengthen the understanding of the effect of sacral radiculopathy on delayed orgasm as well as other sexual dysfunctions. Disclosure: No. [ABSTRACT FROM AUTHOR]

The article discusses spinal dural arteriovenous fistulas (SDAVF), which are the most common vascular anomalies of the spine. SDAVF is an acquired disease that primarily affects middle-aged men between the D4 and L2 vertebrae. The condition is characterized by an abnormal communication between an artery and a draining vein inside the dura, leading to altered venous flow and progressive myelopathy. Symptoms include low back pain, fatigue, and advanced deficits such as bowel and bladder disturbances. Diagnosis is typically done through radiological imaging, and treatment options include surgical intervention or endovascular procedures. Timely diagnosis and intervention can prevent further progression of the disease and reverse symptoms in many patients. [Extracted from the article]

This document is an editorial about Björn Rydevik, who has been awarded the 2024 ISSLS Wiltse Lifetime Achievement Award. Rydevik is a medical doctor and specialist in orthopedic surgery. He has conducted extensive research on nerve injuries and tissue effects, particularly related to spinal nerve compression. His research has contributed to understanding the mechanisms of pain in conditions such as disk herniation and spinal stenosis. Rydevik has also held leadership positions at the University of Gothenburg and has been actively involved in various spine societies, including ISSLS. He is honored to receive this award and expresses gratitude for the opportunities and friendships he has gained through his work in spine research. [Extracted from the article]

The external anal sphincter (EAS) is important for the maintenance of bowel continence and may be compromised by a variety of neuropathic conditions. However, large animal models for the study of EAS functions have been sparse. The EAS guarding reflex was examined by electromyography (EMG) in neurologically intact rhesus macaques ( n = 6) and at 4-6 wk after a unilateral EAS denervation from an L6-S3 ventral root avulsion (VRA) injury ( n = 6). Baseline EAS EMG recordings were quiescent in all subjects, and evoked responses showed an initial large-amplitude EMG activity, which gradually returned to baseline within 1-2 min. At 4-6 wk postoperatively, the EAS guarding reflex showed a significantly reduced EMG response duration of 47 ± 15 s and area under the curve (AUC) of 0.198 ± 0.097 mV·s compared with the corresponding evoked EAS EMG duration of 102 ± 19 s and AUC of 0.803 ± 0.225 mV·s ( P < 0.05) in the control group. Detailed time- and frequency-domain analysis of the evoked EAS EMG responses for the first 40 s showed no difference between groups for the maximum amplitude but a significant decrease for the mean amplitude across the study period and an early AUC reduction for the first 10 s in the VRA injury group. Time-frequency analysis and power spectrum plots indicated decreased intensity and a narrower midrange of frequencies in the VRA injury group. We conclude that the EAS guarding reflex in rhesus macaques shows characteristic EMG features in control subjects and signs of partial target denervation after a unilateral L6-S3 VRA injury. NEW & NOTEWORTHY The external anal sphincter guarding reflex showed initial large-amplitude peaks and a gradual return to a quiescent baseline after a rectal probe stimulus in rhesus macaques. At 4-6 wk after a unilateral ventral root avulsion (VRA) injury, the electromyography duration, mean amplitude, and area under the curve measurements were decreased. Time-frequency analysis and power spectrum plots indicated decreased intensity and a narrowed midrange of frequencies in the VRA injury cohort.

A thorough knowledge of the anatomy of the brachial plexus is pivotal for diagnostic, therapeutic and anaesthetic purposes in order to correctly locate the nerve and reduce the incidence of complications when performing surgery or a local anaesthetic block of the brachial plexus. In this study, the anatomy of the brachial plexus in dogs was reviewed; the depth and diameter of each nerve were evaluated, and the contralateral limbs were compared. Eighteen canine cadavers were included and were divided into: small (SB); medium (MB) and large (LB) breed dogs. After dissection, the spinal roots and the suprascapular, subscapular, axillary, radial, ulnar, median, and musculocutaneous nerves were identified. The following evaluations were recorded: the origin of the nerves from the spinal roots, the roots and the nerve diameters, and the distance of the nerves root from the skin at the level of the scapula-humeral joint and from the interscapular region. A total of thirty-six brachial plexuses were evaluated; all originated from the ventral rami of the C6 to T1 spinal nerves. In the LB dogs, the root and the nerve diameters were larger as compared with the other two groups. In this group, also the mean distance of T1 from the skin at the level of the scapula-humeral joint and the average distance of the nerve roots from the skin of the interscapular region were also greater as compared with the other groups. No significant differences were recorded between the contralateral limbs. In the dogs in the present study, the origin of the nerves of the brachial plexus were similar to those previously reported; however, the presence of minor individual variations was confirmed between the right and the left limbs within the same dog between the right and the left limb. This is the first time that the diameters and the depth of the nerves have been described and positively correlated with body weight. [ABSTRACT FROM AUTHOR]

Introduction: Long non-coding RNAs (lncRNAs) act as key regulators in multiple human diseases. In particular, the dysfunction of lncRNAs in dorsal root ganglion (DRG) contributes to the pathogenesis of neuropathic pain (NP). Nevertheless, the role and mechanism of most lncRNAs in NP remain unclear. Methods: Two classic chronic NP models, including L4 spinal nerve ligation (SNL) model and chronic constriction injury (CCI) of the sciatic nerve, were performed. Mechanical allodynia and heat hyperalgesia were used to evaluate neuropathic pain. DRG microinjection was used to deliver agents into DRG. qRT-PCR, immunofluorescence, immunoprecipitation, western blotting, siRNA transfection, AAV transduction were performed to investigate the phenotypes and molecular basis. Results: Here, we discovered that Rmst as a lncRNA was specifically expressed in Atf3+ injured DRG neurons and significantly upregulated following peripheral nerve damage. Rmst overexpression by direct DRG injection of AAV5-Rmst causes neuropathic symptoms in the absence of nerve damage. Conversely, blocking Rmst expression in injured DRGs alleviated nerve injury-induced pain hypersensitivities and downregulated Dnmt3a expression. Furthermore, we found peripheral nerve damage induced Rmst increase could interact with RNA-binding protein HuR to stabilize the Dnmt3a mRNA. Conclusion: Our findings reveal a crucial role of Rmst in damaged DRG neurons under NP condition and provide a novel target for drug development against NP. [ABSTRACT FROM AUTHOR]

Background: Gadolinium enhancement of spinal nerve roots on magnetic resonance imaging (MRI) has rarely been reported in spinal dural arteriovenous fistula (SDAVF). Nerve root enhancement and cerebrospinal fluid (CSF) pleocytosis can be deceptive and lead to a misdiagnosis of myeloradiculitis. We report a patient who was initially diagnosed with neurosarcoid myeloradiculitis due to spinal nerve root enhancement, mildly inflammatory cerebrospinal fluid, and pulmonary granulomas, who ultimately was found to have an extensive symptomatic SDAVF. Case presentation: A 52-year-old woman presented with a longitudinally extensive spinal cord lesion with associated gadolinium enhancement of the cord and cauda equina nerve roots, and mild lymphocytic pleocytosis. Pulmonary lymph node biopsy revealed non-caseating granulomas and neurosarcoid myeloradiculitis was suspected. She had rapid and profound clinical deterioration after a single dose of steroids. Further work-up with spinal angiography revealed a thoracic SDAVF, which was surgically ligated leading to clinical improvement. Conclusions: This case highlights an unexpected presentation of SDAVF with nerve root enhancement and concurrent pulmonary non-caseating granulomas, leading to an initial misdiagnosis with neurosarcoidosis. Nerve root enhancement has only rarely been described in cases of SDAVF; however, as this case highlights, it is an important consideration in the differential diagnosis of non-inflammatory causes of longitudinally extensive myeloradiculopathy with nerve root enhancement. This point is highly salient due to the importance of avoiding misdiagnosis of SDAVF, as interventions such as steroids or epidural injections used to treat inflammatory or infiltrative mimics may worsen symptoms in SDAVF. We review the presentation, diagnosis, and management of SDAVF as well as a proposed diagnostic approach to differentiating SDAVF from inflammatory myeloradiculitis. [ABSTRACT FROM AUTHOR]

Satellite glial cells (SGCs) that surround sensory neurons in the peripheral nervous system ganglia originate from neural crest cells. Although several studies have focused on SGCs, the origin and characteristics of SGCs are unknown, and their lineage remains unidentified. Traditionally, it has been considered that SGCs regulate the environment around neurons under pathological conditions, and perform functions of supporting, nourishing, and protecting neurons. However, recent studies demonstrated that SGCs may have the characteristics of stem cells. After nerve injury, SGCs up-regulate the expression of stem cell markers and can differentiate into functional sensory neurons. Moreover, SGCs express several markers of Schwann cell precursors and Schwann cells, such as CDH19, MPZ, PLP1, SOX10, ERBB3, and FABP7. Schwann cell precursors have also been proposed as a potential source of neurons in the peripheral nervous system. The similarity in function and markers suggests that SGCs may represent a subgroup of Schwann cell precursors. Herein, we discuss the roles and functions of SGCs, and the lineage relationship between SGCs and Schwann cell precursors. We also describe a new perspective on the roles and functions of SGCs. In the DRG located on the posterior root of spinal nerves, satellite glial cells wrap around each sensory neuron to form an anatomically and functionally distinct unit with the sensory neurons. Following nerve injury, satellite glial cells up-regulate the expression of progenitor markers, and can differentiate into neurons. [ABSTRACT FROM AUTHOR]

This observation in mammals was repeated by Sherrington 40 years later, and the eponym "Schiff-Sherrington reflex" was thus coined (Feinsod, [10]; Ruch & Watts, [27]; Wang, [36]). The case report presented by Frers et al. ([12]) describes an interesting neurological syndrome observed in a zebra, likely to be consistent with the Schiff-Sherrington syndrome (SSS). Interested in those descriptions, Ruch and Watts ([27]) confirmed the Sherrington findings after interrupting conduction in the spinal cord and were the first authors to suggest: "... cephalad release of function should probably be designated the Schiff-Sherrington phenomenon" because Schiff described this syndrome in amphibian spinal cord 40 years before Sherrington. Sir Charles Sherrington first studied this network (Sherrington & Laslett, [32], [33]), currently named the propriospinal system (neurons that are intrinsic to the spinal cord and whose axons terminate within its boundaries) (Conta & Stelzner, [6]). [Extracted from the article]

Unwanted proteins and metabolic waste in cerebral spinal fluid are cleared from the brain by meningeal and nasal lymphatics and the perineural sheath of cranial nerves; however, the distribution and clearance of cerebral spinal fluid (CSF) along the subarachnoid space of the entire spinal cord is not fully understood. Cryo-fluorescence tomography (CFT) was used to follow the movement of tracers from the ventricular system of the brain down through the meningeal lining of the spinal cord and out to the spinal lymphatic nodes. Isoflurane-anesthetized mice were infused into the lateral cerebroventricle with 5.0 µL of quantum dots [QdotR 605 ITKTM amino (PEG)] over two mins. Mice were allowed to recover (ca 2–3 min) and remained awake and ambulatory for 5, 15, 30, 60, and 120 min after which they were euthanized, and the entire intact body was frozen at −80°. The entire mouse was sectioned, and white light and fluorescent images were captured after each slice to produce high resolution three-dimensional volumes. Tracer appeared throughout the ventricular system and central canal of the spinal cord and the entire subarachnoid space of the CNS. A signal could be visualized in the nasal cavity, deep cervical lymph nodes, thoracic lymph nodes, and more superficial submandibular lymph nodes as early as 15 min post infusion. A fluorescent signal could be visualized along the dorsal root ganglia and down the proximal extension of the spinal nerves of the thoracic and lumbar segments at 30 min. There was a significant accumulation of tracer in the lumbar and sacral lymph nodes between 15–60 min. The dense fluorescent signal in the thoracic vertebrae noted at 5- and 15-min post infusion was significantly reduced by 30 min. Indeed, all signals in the spinal cord were ostensibly absent by 120 min, except for trace amounts in the coccyx. The brain still had some residual signal at 120 min. These data show that Qdots with a hydrodynamic diameter of 16–20 nm rapidly clear from the brain of awake mice. These data also clearly demonstrate the rapid distribution and efflux of traces along a major length of the vertebral column and the potential contribution of the spinal cord in the clearance of brain waste. [ABSTRACT FROM AUTHOR]

Simple Summary: Malignant peripheral nerve sheath tumors (MPNSTs) are aggressive and locally invasive neoplasia with the ability to metastasize. MPNSTs are usually associated with the spinal peripheral nerves, less common cranial nerves; are histologically anaplastic and highly aggressive with local connective tissue and muscle invasion; and most require immunocytochemical and ultrastructural verification. The aim of the present case report is to describe the clinical presentation and atypical magnetic resonance imaging (MRI) findings of a nine year old cross-breed with histologically confirmed multiple MPNSTs. The dog initially presented with a two week history of ambulatory tetraparesis. An MRI showed a diffuse intramedullary lesion extending from the C3 to T3 spinal cord segments and the cerebrospinal fluid (CSF) analysis showed marked lymphocytic pleocytosis; thus, Meningomyelitis of Unknown Origin (MUO) was presumptively diagnosed. The dog was treated with an immunosuppressive tapering plan of glucocorticoids and cyclosporine. Despite significant improvement and the stabilization of the clinical signs, the dog acutely deteriorated seven months after and the MRI was repeated. Interestingly, the follow-up MRI showed multiple well-defined intradural-extramedullary mass-like lesions, affecting several spinal nerve roots along the cervicothoracic spinal cord. The histopathological examination confirmed a final diagnosis of multiple MPNSTs, and a metastatic spreading was suspected due to the presence of round cells invading the subarachnoid space. According to the reviewed literature, this is the first reported case of simultaneous MPNSTs in the cervicothoracic spinal cord of a dog. A nine year old cross-breed dog was presented with a two week history of ambulatory tetraparesis and proprioceptive ataxia affecting all four limbs. Meningomyelitis of Unknown Origin (MUO) was presumptively diagnosed based on the magnetic resonance imaging (MRI) findings and cerebrospinal fluid (CSF) analysis. The dog received a tapering dose of glucocorticoids and cyclosporine, showing significant improvement and the stabilization of the clinical signs for seven months. After this period, the dog showed an acute clinical deterioration and a follow-up MRI revealed new multiple lesions affecting different spinal nerve roots along the cervicothoracic spinal cord. Following euthanasia, a final diagnose of multiple malignant peripheral nerve sheath tumors (MPNSTs) was made based on the histopathological examination. MPNSTs can affect the cranial nerves, spinal nerves or the associated nerve roots at any location and can lead to secondary spinal cord compression. The aim of the present case report is to describe the clinical presentation and atypical MRI findings of a dog with histologically confirmed multiple MPNSTs. According to the reviewed literature, this is the first reported case of simultaneous MPNSTs in the cervicothoracic spinal cord of a dog. [ABSTRACT FROM AUTHOR]

microRNAs (miRNAs) are extracellularly released by cells for intercellular communication, while intracellularly, they inhibit the expression of specific genes. An increasing number of studies suggest that extracellular miRNAs have great potential as both therapeutic targets and disease-specific biomarkers in a variety of diseases, including pain disorders. However, little is known about miRNA release from dorsal root ganglion (DRG) neurons in neuropathic pain caused by peripheral nerve injury. In this study, we investigated the changes in the extracellular release of miRNAs from DRG neurons in a rat model of neuropathic pain induced by chronic constriction injury of the sciatic nerve. We found increased release of six miRNAs (let-7d, miR-21, miR-142-3p, miR-146b, miR-203-3p and miR-221) from primary cultured DRG neurons prepared from rats 7 days after nerve injury. Among these, miR-221 was also increased in serum from days 7 to 28 after nerve injury. In contrast, serum miR-221 levels and its release from DRG neurons were unchanged in an inflammatory pain model produced by intraplantar injection of complete Freund's adjuvant. These results suggest that the increased release of specific miRNAs by DRG neurons may be involved in the pathophysiology of neuropathic pain through extracellular as well as intracellular mechanisms. Furthermore, serum miR-221 may be useful as a biomarker of neuropathic pain caused by peripheral nerve injury. [ABSTRACT FROM AUTHOR]

Accumulating observations suggest that peripheral somatosensory ganglia may regulate nociceptive transmission, yet direct evidence is sparse. Here, in experiments on rats and mice, we show that the peripheral afferent nociceptive information in mice undergoes dynamic filtering within the dorsal root ganglion (DRG) and suggest that this filtering occurs at the axonal bifurcations (t-junctions). Using synchronous in vivo electrophysiological recordings from the peripheral and central processes of sensory neurons (in the spinal nerve and dorsal root), ganglionic transplantation of GABAergic progenitor cells, and optogenetics, we demonstrate existence of tonic and dynamic filtering of action potentials traveling through the DRG. Filtering induced by focal application of GABA or optogenetic GABA release from the DRG-transplanted GABAergic progenitor cells was specific to nociceptive fibers. Light-sheet imaging and computer modeling demonstrated that, compared to other somatosensory fiber types, nociceptors have shorter stem axons, making somatic control over t-junctional filtering more efficient. Optogenetically induced GABA release within DRG from the transplanted GABAergic cells enhanced filtering and alleviated hypersensitivity to noxious stimulation produced by chronic inflammation and neuropathic injury in vivo. These findings support "gating" of pain information by DRGs and suggest new therapeutic approaches for pain relief. [ABSTRACT FROM AUTHOR]

In 1891, Wynter and Quincke aspirated cerebrospinal fluid (CSF) from the subarachnoid space for the treatment of raised intracranial hypertension associated with tubercular meningitis. However, all Quincke and Wyner's subjects died soon after. In 1898, Karl August Bier injected cocaine 10-15mg into 7 patients, himself and his assistant, Hildebrandt, and four of the subjects all described the symptoms associated with postdural puncture headache. By the early 1900s, spinal anesthesia using large bore needles was reported to be a complication in 50% of subjects. The spinal cord is a long, thin, tubular structure made up of nervous tissue that is continuous with the brainstem and terminates in the conusmedullaris. The caudaequina is formed by the lumbar and sacral roots elongating to reach their corresponding intervertebral foramina. The inner gray matter consists of nerve cell bodies arranged to give the region a butterfly-shape, and white matter contains only the nerve fiber. The cerebrospinal fluid (CSF) is formed daily by the choroid plexus of the cerebral ventricles, with 30 to 80 ml occupying the subarachnoid space from T11-T12 downward. The arachnid mater is the principal barrier to drugs crossing into the CSF and is estimated to account for 90% of the resistance to drug migration. The epidural space surrounds the dura mater and spinal nerves and roots. Methodology: This randomized study was conducted after obtaining permission from the institutional ethical committee, under the Department of Anesthesiology and Critical care, Gauhati Medical College and Hospital for a period of one year. 142 adults were selected for the study who met the following criteria: age between 18 to 45 years, American Society of Anesthesiologist's physical status II, informed and written consent, surgery initiated when sensory block level reached T4, demographic data (age, weight, height, BMI), duration of surgery, number of hypertensive episodes, total vasopressin requirements and intraoperative nausea and vomiting. Postoperative analgesia protocol was Tramadol 2mg/kg iv 12hrs apart; paracetamol 10mg/kg IV was applied when analgesia was inadequate. Postdural puncture headache was evaluated according to the International Classification of Headache Disorders (ICHD-II) diagnostic criteria. Conclusion: The median approach of spinal anaesthesia is preferred in pregnant women undergoing caesarean section due to its lower incidence of post-dural puncture headache. [ABSTRACT FROM AUTHOR]

Spinal lesions are a known manifestation of neurofibromatosis type 1 (NF1). The aim of this retrospective review was to analyze and report the prevalence of spinal lesions on imaging in a large NF1 center. The data were collected from a period of 62 months from a cohort of 514 patients. Data were collected from multidisciplinary team meeting reports that included radiologic reports of each patient investigating 20 distinct variables. The prevalence of each of these lesions was calculated, and any statistically significant associations were investigated using the χ2 test. Four-hundred forty-seven patients had classic NF1, and 67 patients had spinal NF1. Many of the patients had spinal abnormalities; 25.7% of these patients were found to have dural ectasia, whereas 44.9% of patients had a spinal deformity. A statistically significant association between dural ectasia and spinal neurofibromatosis was established (P < 0.05). An additional statically significant association was established between dural ectasia and spinal deformity (P < 0.00001). The patients with spinal nerve root tumors were identified, and it was found that 49.8% of patients possessed these tumors, whereas 56.3% of these tumors were intraspinal tumors. The most common region affected was the cervical spine, and the most common spinal level was C2. This high prevalence of spinal tumours in mobile areas of the spine is possibly the result of a combination of genetic predisposition and repeated microtraumas resulting in tumor formation. This is the largest reported study of spinal lesions in NF1 based on imaging and offers insights into the etiology and relationships between lesions. [ABSTRACT FROM AUTHOR]

Hybrid therapy, consisting of separation surgery followed by stereotactic body radiation therapy, has become the mainstay treatment for radioresistant spinal metastases. Histology-specific outcomes for hybrid therapy are scarce. In clinical practice, colorectal cancer (CRC) is particularly thought to have poor outcomes regarding spinal metastases. The goal of this study was to evaluate clinical outcomes for patients treated with hybrid therapy for spinal metastases from CRC. This retrospective study was performed at a tertiary cancer center. Adult patients with CRC spinal metastasis who were treated with hybrid therapy for high-grade epidural spinal cord or nerve root compression from 2005 to 2020 were included. Outcome variables evaluated included patient demographics, overall survival and progression-free survival, surgical and radiation complications, and clinical-genomic correlations. Inclusion criteria were met by 50 patients. Progression of disease occurred in 7 (14%) patients at the index level, requiring reoperation and/or reirradiation at a mean of 400 days after surgery. Postoperative complications occurred in 16% of patients, with 3 (6%) requiring intervention. APC exon 14 and 16 mutations were found in 15 of 17 patients tested and in all 3 of 7 local failures tested. Twenty patients (40%) underwent further radiation due to disease progression at other spinal levels. Hybrid therapy in patients with CRC resulted in 86.7% local control at 2 years after surgery, with limited complications. APC mutations are commonly present in CRC patients with spine metastases and may suggest worse prognosis. Patients with CRC spinal metastases commonly progress outside the index treatment level. [ABSTRACT FROM AUTHOR]

Activation of neurons and glial cells in the dorsal root ganglion is one of the key mechanisms for the development of hyperalgesia. The aim of the present study was to examine the role of neuroglial activity in the development of opioid-induced hyperalgesia. Male rats were treated with morphine daily for 3 days. The resultant phosphorylation of extracellular signalregulated kinase (ERK) 1/2 in the dorsal root ganglion was analyzed by immunohistochemistry and Western blotting. Pain hypersensitivity was analyzed using behavioral studies. The amount of cytokine expression in the dorsal root ganglion was also analyzed. Repeated morphine treatment induced hyperalgesia and marked induction of phosphorylated ERK1/2 in the neurons and satellite glial cells on day 3. An opioid receptor antagonist, toll like receptor-4 inhibitor, MAP/ERK kinase (MEK) inhibitor and gap junction inhibitor inhibited morphine-induced hyperalgesia and ERK1/2 phosphorylation. Morphine treatment induced alteration of cytokine expression, which was inhibited by the opioid receptor antagonist, toll like receptor-4 inhibitor, MEK inhibitor and gap junction inhibitor. Dexamethasone inhibited morphine-induced hyperalgesia and ERK1/2 phosphorylation after morphine treatment. The peripherally restricted opioid receptor antagonist, methylnaltrexone, inhibited hyperalgesia and ERK1/2 phosphorylation. Morphine activates ERK1/2 in neurons and satellite glial cells in the dorsal root ganglion via the opioid receptor and toll like receptor-4. ERK1/2 phosphorylation is gap junction-dependent and is associated with the alteration of cytokine expression. Inhibition of neuroinflammation by activation of neurons and glia might be a promising target to prevent opioid-induced hyperalgesia. [ABSTRACT FROM AUTHOR]

Neurosensory disorders such as pain and pruritus remain a major health problem greatly impacting the quality of life, and often increasing the risk of mortality. Current pre-clinical models to investigate dysfunction of sensory neurons have shown a limited clinical translation, in part, by failing to mimic the compartmentalized nociceptor anatomy that exhibits a central compartment containing the soma and a peripheral one harboring the axon endings with distinct molecular and cellular environmental composition. Thus, there is a need to validate compartmentalized preclinical neurosensory models for investigating the pathophysiology of peripheral sensory disorders and to test drug candidates. Here, we have addressed this issue and developed a microfluidic-based preclinical nociceptor model and validated it for investigating inflammatory and neuropathic peripheral disorders. We show that this model reproduces the peripheral sensitization and resolution produced by an inflammatory soup and by the chemotherapeutic drug paclitaxel. Furthermore, compartmentalized nociceptor primary cultures were amenable to co-culture with keratinocytes in the axonal compartment. Interaction of axonal endings with keratinocytes modulated neuronal responses, consistent with a crosstalk between both cell types. These findings pave the way towards translational pre-clinical sensory models for skin pathophysiological research and drug development. [ABSTRACT FROM AUTHOR]

Background: Low back pain is one of the most common causes of clinic referrals. In most patients, radicular pain results from the compression or injury of the proximal nerve root or dorsal root ganglion. Objectives: This study aimed to investigate the electrodiagnostic involvement of lumbar nerve roots in patients with lumbar radicular pain undergoing electromyography (EMG) and nerve conduction study. Methods: The sample population was selected from 18-70-year-old patients who had files in the clinic, complaining of lumbar pain radiating to the lower extremities for at least 2 months. Patient data were extracted from the available data and recorded in a separate anonymous information sheet. Results: This study was carried out on 352 patients with lumbar radicular pain. In addition to radicular pain, paresthesia was present in 86 patients (24.4%). Out of 352 patients with radicular pain, 294 cases (83.52%) showed unilateral or bilateral involvement in EMG. Among those who had paresthesia, 74 patients (86%) showed nerve root involvement in EMG. Conclusions: This study indicated the compatibility between lumbar radicular pain symptoms and the features observed in EMG, particularly in areas of paresthesia or the side of pain. Therefore, the patient's symptoms can help predict nerve root involvement in the electrodiagnostic study before conducting this test. [ABSTRACT FROM AUTHOR]

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Back pain is a main cause of disability and greatly affects life quality and the healthcare cost. The objective of the study was to identify the factors that are associated with the development of chronic musculoskeletal back pain in the working age population. A main group included 144 patients with chronic musculoskeletal back pain. Of these, 89 (61.8%) were women and 55 (38.2%) were men. The median age of the patients was 43 [39; 48] years. Magnetic resonance imaging (MRI) was performed using Magnetom Symphony and Magnetom Verio (Siemens, Germany) machines at a magnetic field strength of 1.5 T and revealed intervertebral disc protrusions extending less than 3 mm beyond the edge of the vertebral body without compressing the spinal nerve roots and spinal nerves. A comparison group included 37 healthy subjects (22 women and 15 men, median age 40 [30; 49] years). Significant factors associated with chronic back pain in the working age population were found to include tobacco smoking (p = 0.000), elevated body mass index (BMI) (p = 0.0033), sedentary lifestyle and lack of physical activity (p = 0.000), intense use of computer technologies at work and at home for at least 5 days a week (p = 0.000), and usage of a smartphone or a tablet in a prone position for at least 3 hours a day (p = 0.025). The conclusion is that both clinical and behavioral characteristics of patients, as well as their occupational and leisure-time physical activities, are necessary to identify the factors predisposing to development of chronic skeletomuscular back pain. [ABSTRACT FROM AUTHOR]

Introduction: The excitability of spinal motor neurons (MN) can be altered through subthreshold currents, such as transcutaneous spinal direct-current stimulation (tsDCS). Current evidence shows that tsDCS can interfere with ascending somatosensory pathways and lower motor neurons' (LMN) excitability, which points to its therapeutic potential for repairing altered spinal responses. We aim to define the best tsDCS montage for maximizing the electric field (E-field) in the lumbar spinal cord (L-SC) by computer modeling; and to apply this montage to measure the effect on LMN excitability and somatosensory evoked potentials (SSEP). Methods: A human volume conductor model was obtained from an available database. The E-field distribution was calculated considering three different electrode settings aiming at maximizing the field at L-SC and right dorsal root ganglia (DRG). The best electrode setting was then selected and applied in a blind crossover pseudo-randomized study including 14 subjects. tsDCS was delivered for 15 min (cathodal vs. sham) over L2 vertebra level (4 mA, 144 mC/cm²), and its effect on F-waves, H-reflex (including homosynaptic depression, HD) and SSEPs was investigated in the lower limbs. Results: All simulated montages showed higher current density and E-field magnitudes between the electrodes (>0.15 V/m), with a major longitudinal component and with rostral-caudal direction. The induced E-field involved the sensory ganglia and was maximum in the right T8-left L2 montage, which was the one selected for the experimental protocol. We disclosed a statistically significant increase of the H-reflex amplitude at 0.1 Hz, after cathodal tsDCS (c-tsDCS) on both sides. No other significant change was observed. Discussion: Our results can suggest the c-tsDCS applied to the L-SC and DRG can modulate synaptic efficiency increasing lower motor neurons response to Ia fibers excitation. The possible implications of our findings for treating clinical conditions will be addressed in future studies. [ABSTRACT FROM AUTHOR]

Summary. A 9-year-old 35.6 kg (90 lb) female neutered German Shepherd dog was admitted due to progression of tetraparesis. The dog presented pyrexia, mild leukocytosis, and nonambulatory tetraparesis with decreased general proprioception and withdrawal in all the limbs, with the front limbs more severely affected. Magnetic resonance imaging revealed T2-weighted image (WI) hyperintense, contrast-enhancing lesion at the level of the C6-C8 spinal nerves, and epidural fat, suspected to be an infiltrative neoplasm. Medical treatments during hospitalization included glucocorticoids, antibiotics, and supportive care. Euthanasia was elected 4 days later due to financial constraints, despite clinical improvement. Postmortem findings revealed septic emboli (SE) in the epidural fat exiting the canal and following the tract of the spinal nerve roots and nerves. Staphylococcus pseudintermedius was identified as the causative agent. Although the incidence of SE without severe systemic disease is considered low in dogs, it should be considered in the differential diagnosis of focal intraspinal disease. [ABSTRACT FROM AUTHOR]

Abstract: Central neuropathic pain is a core clinical sign of syringomyelia in humans and Cavalier King Charles Spaniel (CKCS) dogs. This histopathological study used spinal cords from CKCS dogs with syringomyelia to investigate the following conditions: (1) whether specific structural cervical spinal cord entities involved in nociception were affected by loss of neuroparenchyma or other pathological changes in CKCS dogs with pain-related behaviour and phantom scratching, (2) whether pain-related behaviour or phantom scratching correlated with loss of a specific anatomical entity or upregulation of glia cells, and (3) whether syringomyelia-related lesions affected specific functional spinal cord units of nociception. Spinal cord segments C1-C8 from CKCS dogs with magnetic resonance imaging-confirmed syringomyelia and clinical signs of pain and phantom scratching (n = 8) were compared with those from CKCS dogs without syringomyelia (n = 4). Dogs with unilateral scratching (n = 7) had a volume loss ( P = 0.043) of the dorsal horn laminae I-III in the ipsilateral side compared with the contralateral dorsal horn. A clear pattern of ipsilateral changes in the dorsal root entry zone characterised by deafferentation and reorganization of first-order axons into deeper laminae was found in cases with lateralised scratching. Significant changes in cell number density were not found for astrocytes or microglia, suggesting that the dogs represented cases of end-stage syringomyelia and thus could not reveal astrogliosis and microgliosis, which may be involved in the early phases of syrinx development and phantom scratching. The present relationship between clinical findings and dorsal horn and pain pathway pathology in CKCS dogs suggests that these dogs may be of interest as a supplement to experimental model pain research. [ABSTRACT FROM AUTHOR]

Nerve root signature presents as discomfort and lameness in a single limb related to disease involving the spinal nerve roots or spinal nerve itself. It has been well described in dogs with disc protrusion or herniation. In this case, a 10‐month‐old, female, entire Bengal cat presented with nerve root signature and deterioration in ability to ambulate following acetabular fracture repair. The cat was reluctant to move and markedly uncomfortable on even gentle manipulation of the pelvic limb. A right sacral wing fracture was suspected to be compressing the right L7–S1 nerve root on computed tomography. Revision surgery was performed to remove the fragment, and the cat gradually made a full recovery. Compression of nerve roots L7–S1 by sacral fractures causing nerve root signature should be considered in cats presenting non‐ambulatory and exquisitely uncomfortable after surgery. [ABSTRACT FROM AUTHOR]