Title

SPINAL INJURIES: CLINICAL AND MEDICO-LEGAL FEATURES

Writer

Christian Zanza1,2,3· Turner Union4· Cristina Naturale5· Yaroslava Longhitano6,7· Angela Saviano3· Andrea Piccioni3· Aniello
Maiese8· Michela Ferrara9· Gianpietro Volonnino9· Giuseppe Bertozzi10· RobertaGrassi11· Fabrizio Donati12· Michele Ahmed
Antonio Karaboue10

Journal name

Medical Radiology (2023) 128:103–112

Year

January 31, 2023

Head

Spinal cord trauma is described as the leading cause of morbidity and mortality among young adults following road and
workplace trauma worldwide, and it represents a significant proportion.
Spinal trauma is an important cause of disability worldwide. Injuries to the cervical spine (CS) frequently occur following major
trauma. 5–10% of patients with blunt trauma experience cervical spine injury. The cervical spine accounts for ~50% of all spinal
injuries. Determination of CS stability is a common challenge in the acute care of patients with trauma. Several issues are of
particular concern: who needs CS imaging; what imaging to obtain; when to calculate raphy tomogradiography (CT), magnetic
resonance imaging (MRI), or fexion/extension (F/E); and how significant ligament injury can be excluded in comatose patients.
CT and MRI both have a role to play.

Method
An overview of the application of the same method in forensic pathology is also provided highlighting possible future
biomarkers to facilitate the diagnosis of acute TBI.

Results
of forensic pathology, a recent study focused on the possibility of identifying a new biomarker of spinal trauma both for
diagnostic purposes and as a therapeutic target: mi-RNA, whose behavior (up- or down-regulation), once standardized,
could also allow the identification of false-negative cases as well as possible the interplay between these events and the
organism's other systems and apparatus
However, further research is needed to better understand the extent of these tools, without forgetting that only
through a multidisciplinary approach can a diagnosis be achieved

Conclusion

The evolution, over time, of knowledge about spinal trauma and, in particular, cervical trauma, has made it possible to
devise more precise imaging techniques that can be used in acute events. It seems undeniable that CT and MRI play
complementary roles in acute spinal trauma.
CT is the fastest, easiest, and most accessible first-line imaging modality. The information provided regarding
traumatic changes to normal anatomy, especially in the bony compartments, is fundamental for the clinician who
must decide on the course of a traumatized patient.
MRI is unmatched in the evaluation of soft tissues such as discs, ligaments, and spinal cord. The use of magnetic
resonance has clear indications in acute trauma such as in patients who have persistent neurological deficits or in patients
with persistent pain in cases of inconclusive CT.
MRI has an extraordinary ability to reveal the location and severity of spinal cord injuries, especially in patients who
have incomplete injuries. In these cases, finding the exact lesion allows the clinical condition to further worsen.
The decision to use either technique, when an emergency is involved, must take into account the stability or instability of
the patient. MRI, although providing more information, will not be the first imaging choice in unstable patients due to the long
imaging time compared to CT.
Advanced techniques provide greater and more detailed information about axonal and myelin integrity that adds to the
information obtained from conventional sequencing.
The evolution of imaging and neuroimaging techniques has made great progress in recent years.

However, if the imagery is negative and faced with very indicative semiotics, then the existence of SCIWORA should
not be forgotten
In the next 50 years, this evolution promises further improvements, some also borrowed from evidence originating from
forensic pathology, that will result in increasingly better diagnostic accuracy and better prognostic vision in patients affected
by spinal trauma.

Title

Immune response after traumatic spinal cord injury: Pathophysiology and therapy

Writer
Robert C.Sterner1 and Rosalie M. Sterner2* Wisconsin-Madison, Madison, WI, United States,2Department of
Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States6

journal name
Frontiers in Immunology 01 frontiersin.org
Sterner and Sterner 10.3389/fimmu.2022.1084101

Year
January 6, 2023

Head
Traumatic spinal cord injury (SCI) is a devastating condition that is often associated with significant loss of function and/or
permanent disability. The pathophysiology of SCI is complex and occurs in two phases. First, mechanical damage due to
trauma causes acute cell dysfunction and cell death. Then, subsequent secondary injury mechanisms cause cell dysfunction
and cell death over days, weeks, or even months. Among secondary injury mechanisms, inflammation has been shown to be
a major determinant of secondary injury severity and significantly worsens cell death and functional outcomes. Thus, in
addition to surgical management of SCI, selective targeting of the immune response after SCI may substantially reduce the
development of secondary injuries and improve patient outcomes. To develop such therapies, a detailed molecular
understanding of the timing of the immune response after SCI is required. Recently, several studies have mapped
cytokine/chemokine patterns and cell proliferation after SCI. In this review, we examine the immune response underlying the
pathophysiology of SCI and assess current and future therapies including pharmaceutical therapy, stem cell therapy, and the
exciting potential of extracellular vesicle therapy.

Method

Results
Results of stem cell transplantation trials in chronic stage SCI patients vary with some trials showing recovery rates of up
to 100% while other trials show no improvement based on the ASIA impairment scale. In a study that showed no
improvement based on the AISA impairment scale, patients showed some improvement on somatosensory evoked potential
(SEP) and motor evoked potential (MEP) testing indicating some benefit in these patients. Another study showed a higher
SCI recovery rate after receiving stem cell therapy in matched control patients. In a group of 70 randomly divided patients,
34% of patients treated with intrathecal bone marrow-derived mesenchymal stromal cell therapy showed increased AISA
levels compared with 0% of patients in the control group. Similarly, in a group of 34 ASIA A SCI randomly divided into a
control group, rehabilitation group, and cell transplantation group, only patients who received cell transplantation showed
significant motor, sensory, and urinary tract recovery compared with their status before treatment.

Conclusion
given the complexity of SCI pathophysiology, it is possible that these patients may benefit not only from
immunotherapeutic agents but also combining other synergistic therapies including stem cell therapy/extracellular
vesicle therapy and neuromodulation, spinal cord stimulation, and prosthetic devices that are beyond the scope of SCI .
Recent studies have also shown that EV therapy provides better and beneficial outcomes because EV therapy
reduces the concerns of immunogenicity and uncontrolled proliferation/differentiation associated with cell transplantation.
Although EV therapy has the potential to be revolutionary, several challenges such as those described in this review need
to be overcome before it becomes a mainstream therapy. While challenges in the development of pharmaceutical, stem
cell, and EV therapies for SCI remain, new strategies and potential solutions continue to develop that may provide a path
forward to provide better outcomes for SCI patients.