Cytonics (United States)

Central cord syndrome (CCS) is an incomplete spinal cord injury that consists of both sensory and motor changes of the upper and lower extremities. CCS most commonly occurs after trauma to the cervical spine leading to acute neurological changes. Despite being the most common incomplete spinal cord injury with the best outcomes, optimal treatment remains controversial. Although clinical practice has shifted from primarily conservative management to early surgical intervention, many questions remain unanswered and treatment remains varied. One of the most limiting aspects of CCS remains the diagnosis itself. CCS, by definition, is a syndrome with a very specific pattern of neurological deficits. In practice and in the literature, CCS has been used to describe a spectrum of neurological conditions and traumatic morphologies. Establishing clarity will allow for more accurate decision making by clinicians involved in the care of these injuries. The authors emphasize that a more precise term for the clinical condition in question is acute traumatic myelopathy: an acute cervical cord injury in the setting of a stable spine with either congenital and/or degenerative stenosis.

INTRO: This investigation attempted to determine the ability of the Fibronectin-Aggrecan complex (FAC) to predict response to biologic therapy with concentrated autologous alpha-2-macroglobulin (A2M) for patients with LBP from DDD. METHODS: This study was a prospective cohort of 24 patients with low back pain and MRI positive for DDD. Outcome Measures included Oswestry disability index (ODI) and visual analog scores (VAS), noted at baseline and 3 and 6-month follow-up. Primary outcome of clinical improvement was defined as patients with both a decrease in VAS of at least 3 points and ODI >20 points. All patients underwent lavage for molecular discography, delayed FAC analysis and injection of platelet poor plasma (PPP) rich in A2M at the time of the intradiscal injection. RESULTS: Patients with FACT-positive assays were significantly more likely to show improvement in their VAS and ODI at follow-up. Mean VAS improvement in FACT-positive patients was 4.9 ±0.9 and 4.0 ±1.0 at 3 and 6-months, compared to 1.5 ± 1.2 and 2.3 ±1.3 in those with negative FACT (p < 0.0001). ODI improved on average 37 ±9.3 and 28 ±14 points at 3 and 6-months in FACT-positive patients compared to 9.4 ±11.9 and 12.6 ±11.8 points at 3 and 6-months in FACT-negative patients (p<0.0001). Correlation analysis demonstrated that a FACT-positive test correlates with improvement in 3-month VAS (Pearson r = 0.83; p < 0.0001) and ODI (Pearson r = 0.71; p<0.0001) and 6-month VAS (Pearson r = 0.58; p<0.0001) and ODI (Pearson r = 0.53; p<0.0001). When a 20-point ODI improvement cut-off is applied, 77% of FACT+ patients and 27% of FACT-negative patients meet this strict definition of clinical improvement. DISCUSSION: Patients who are FAC+ within the disc are more likely to demonstrate clinical improvement following intradiscal autologous A2M injection. The results of this investigation suggest that autologous A2M may be an efficacious biologic treatment in discogenic pain and that FAC may be an important biomarker in patient selection for this treatment. We utilized a definition of clinical improvement that was in excess of the minimal clinically improved difference (MCID). This study demonstrates that a PPP concentrate rich is A2M is likely to result in clinical improvement of LBP in patients who demonstrate the FAC in the suspected disc.