Korean Journal of Neurotrauma最新文献

Objective: This study compared the outcomes of short-segment in situ fixation (SSF), long-segment fixation (LSF), and corpectomy for thoracolumbar burst fractures to identify the optimal fixation method.

Methods: We retrospectively analyzed 67 patients grouped into SSF (n=24), LSF (n=22), and corpectomy (n=21). Clinical and radiological parameters were assessed, including pre- and postoperative hemoglobin, numeric rating scale scores, American Spinal Injury Association scale grades, anterior vertebral body height (AVBH), spinal canal encroachment, Cobb angle, local kyphotic angle, operative time, and blood loss.

Results: Preoperatively, the corpectomy group demonstrated significantly lower AVBH (49.7%) and greater spinal canal encroachment (64.9%) compared with the SSF (62.6% and 39.9%) and LSF (58.4% and 43.0%) groups (p=0.006 and p<0.001, respectively). Postoperative outcomes were comparable among the three groups. Postoperative AVBH was 19.7 mm, 20.0 mm, and 20.5 mm in the SSF, LSF, and corpectomy groups, respectively (p=0.801). Likewise, postoperative local kyphotic angles were 9.4°, 10.8°, and 7.8°, respectively, showing no statistically significant differences (p=0.499). Effective spinal canal decompression was achieved in all groups. However, the corpectomy group required significantly longer operative times (mean, 343.1 minutes; p<0.001) and experienced greater intraoperative blood loss (mean, 1,634.2 cc; p=0.054).

Conclusion: Severe preoperative AVBH loss (≤54.93%) and spinal canal encroachment (≥54.39%) may serve as practical thresholds for selecting corpectomy to achieve adequate decompression. In contrast, when these parameters are within acceptable ranges, SSF may be preferred in younger patients as it is less invasive, requires shorter operative time, and provides outcomes comparable to LSF.

Spinal cord injury remains one of the most challenging neurological disorders due to limited intrinsic regeneration. Neural stem cell (NSC) transplantation offers a promising strategy for restoring neural circuitry and functional recovery. Among delivery methods, direct intramedullary transplantation provides the most localized graft placement and has shown encouraging safety and efficacy in early clinical trials. This review summarizes current evidence and technical considerations for intramedullary NSC transplantation. Key factors influencing outcomes include timing after injury, cell source, surgical approach, and host microenvironment. Advances in microsurgical delivery techniques and biomaterial scaffolds have improved graft survival and integration while minimizing procedure-related risks. Clinical data demonstrate that intramedullary NSC transplantation is feasible and generally safe, with early signals of motor improvement. Nevertheless, challenges remain in achieving consistent cell engraftment and long-term functional gains. Future work should focus on refining transplantation parameters, establishing standardized surgical protocols, and conducting multicenter trials with long-term follow-up to confirm clinical efficacy. By integrating current findings, this review provides a concise overview of surgical evolution and translational progress, highlighting intramedullary NSC transplantation as a key frontier in regenerative spinal surgery.

Spinal cord injury (SCI) remains one of the most devastating neurological conditions with poor prognosis and limited therapeutic options. Early surgical decompression has been established as the cornerstone of acute management, yet multiple pharmacologic strategies have been extensively investigated to improve neurological outcomes. High-dose methylprednisolone sodium succinate, once widely adopted, ultimately failed to demonstrate consistent efficacy, underscoring the challenges of translating preclinical promise into clinical benefit. Advances in understanding the sequential pathophysiology of SCI, including excitotoxicity, oxidative stress, inflammation, apoptosis, glial scarring, and chronic inhibitory signaling, have broadened therapeutic targets across temporal phases of injury. In this narrative review, we revisit historical pharmacologic therapies such as corticosteroids, and highlight current and emerging candidates including riluzole, minocycline, granulocyte colony-stimulating factor, and biologics targeting the Rho/ROCK pathway (Cethrin, anti-Nogo-A, and anti-repulsive guidance molecule A antibodies). Although compelling preclinical evidence exists, most clinical trials have been limited by patient heterogeneity, narrow therapeutic time windows, and outcome assessment challenges, preventing any drug from achieving guideline-level endorsement. Future success will likely depend on tailored multimodal regimens according to patient stratification, optimized therapeutic timing and delivery, and integration with surgical decompression, hemodynamic management, rehabilitative interventions, and novel bioengineered strategies. Continued efforts in these directions remain essential to establish pharmacologic therapy as a critical component of multimodal SCI care.

Traumatic spinal cord injury (tSCI) is a neurological disorder that leads to long-term disability, significant economic burden, and limited treatment options. Accurate and timely diagnosis, as well as reliable prognosis, are crucial for acute treatment, rehabilitation, and long-term treatment planning. Recent advances in artificial intelligence (AI) and machine learning have demonstrated significant potential to support the diagnostic workflow and predict clinical outcomes in patients with tSCI. For diagnostic purposes, models based on convolutional neural networks trained using magnetic resonance imaging and diffusion tensor imaging showed high accuracy in detecting cord damage and classifying injury severity. A variety of prognostic models, ranging from traditional logistic regression to advanced neural networks and deep learning-based radiomics, have been applied to predict functional recovery, ambulatory status, and survival. Although AI-based approaches generally have better prediction accuracy than conventional methods, several limitations remain, such as limited dataset sizes, heterogeneity across studies, lack of external validation. Future studies should incorporate multicenter collaborations, standardized reporting frameworks, and integration of multimodal data to enhance clinical generalizability and applicability. With further improvements, AI will play a crucial role in supporting clinicians in making decisions about tSCI and in patient rehabilitation.

Spinal cord injury (SCI) causes severe motor, sensory, and functional impairments, often leading to long-term disability. Conventional rehabilitation is labor-intensive and resource-demanding, whereas robotic rehabilitation enables repetitive, task-specific, and intensive training that promotes neuroplasticity. Evidence from clinical and randomized studies shows that upper limb robotic systems, including end-effector and exoskeleton types, improve motor outcomes, especially in the subacute phase. Moreover, hybrid approaches that integrate functional electrical stimulation or spinal cord stimulation appear to provide additional benefits. For lower extremity rehabilitation, ambulatory exoskeletons such as ReWalk, Ekso, Indego, HAL, Rex, Arke, and HANK have been demonstrated to offer safe and feasible gait training, with reported improvements in walking independence, balance, and stride parameters, although enhancements in gait speed remain modest. Preliminary evidence also suggests that exoskeleton-assisted walking may positively influence bowel and urinary function; however, current data are limited. Overall, robotic rehabilitation appears to be a safe and feasible adjunct to conventional therapy, offering moderate improvements in motor function and quality of life in patients with SCI. Nevertheless, further high-quality clinical trials and the integration of neuromodulatory techniques are required to more clearly establish its efficacy and define its role in routine clinical practice.

Traumatic spinal cord injury (SCI) causes severe neurological and functional disability with major socioeconomic impact. The primary trauma initiates ischemia, excitotoxicity, and inflammation, leading to progressive neuronal loss and glial scarring. Early surgical decompression is a key strategy to limit secondary injury and promote recovery, though optimal timing remains debated. Preclinical data consistently favor early intervention, while clinical studies define "early" variably (<8-72 hours). Evidence from multicenter trials and meta-analyses indicates that decompression within 24 hours offers nearly a threefold higher chance of ≥2-grade improvement on the ASIA Impairment Scale, along with better motor recovery, functional independence, and fewer complications. Ultra-early (<8-12 hours) decompression may provide additional benefit in select cases, but supporting data remain limited. The strongest effects are seen in cervical and incomplete injuries, with less consistent results in thoracic and polytrauma cases. Emerging adjuncts such as expansile duraplasty and intraoperative ultrasound may further optimize outcomes. The AO Spine-Praxis guidelines strongly recommend decompression within 24 hours, though global disparities in resources persist. Overall, evidence supports early-preferably within 24 hours-decompression to enhance recovery after acute SCI, with future studies needed to refine timing and standardize protocols worldwide.

Objective: Traumatic brain injuries (TBIs) impact public health. In Cameroon, few studies have been conducted to map its current burden. The aim of this study was to characterise TBI over 5 years among patients treated at the Laquintinie Hospital of Douala (LHD) in Cameroon.

Methods: We conducted a retrospective study over 5 years (January 2023 to December 2017) at the Neurosurgery Department of LHD. During this period, we enrolled 8,902 patients. We registered sociodemographic data, context, injury mechanism and etiologies of TBI from the department's database. The data was analysed using R software and Pearson's χ² test of independence or Fisher's exact test were used as association tests.

Results: The mean age of the patients was 34±15 years (1-99 years). Majority were men (78%), lived in urban areas (96%) and were self-employed (35%). TBI were classified as mild (83.4%), moderate (11.3%) and severe (5.4%). Road traffic accidents was the major cause of TBI (79%), involving motorbike taxis (53%) and pedestrians (34%). Alcohol consumption (14%) and vehicle overloading (22%) were associated with injuries. Poor safety measures through non use of seatbelts and helmets were associated with the severity of TBI. Mortality was significantly more common in severe cases (2%) compared to moderate (1.1%) and mild cases (0.4%).

Conclusion: Preventive measures targeting road safety, alcohol consumption and vehicle overloading are essential to reduce the prevalence of TBIs in Cameroon.

Cerebral fat embolism (CFE) is a rare but severe complication of trauma, most often linked to long bone or pelvic fractures. We report a 71-year-old woman who developed severe CFE after a pelvic fracture, resulting in profound coma despite early supportive treatment. Brain MRI showed the characteristic "starfield" pattern confirming the diagnosis. A systematic literature review identified 12 cases of severe CFE (Glasgow Coma Scale [GCS] ≤9) reported since 2010, including the present case. Initial GCS ranged from 3 to 9, with lower scores generally predicting poorer outcomes. Although some patients recovered after deep coma, no consistent prognostic factor-such as GCS score, corticosteroid therapy, or timing of orthopedic surgery-was identified. However, early diagnosis, aggressive supportive management, and timely fracture fixation were repeatedly emphasized as essential to improving outcomes. Multidisciplinary care involving neurologists, intensivists, and orthopedic surgeons was critical. Severe CFE remains an uncommon but often devastating condition with high morbidity. Prognosis is variable but tends to correlate with initial neurological status. Greater awareness and early intervention may enhance survival and neurological recovery, while further studies are needed to clarify prognostic determinants and establish standardized management strategies.