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Charest-Morin R.,University of Quebec | Dea N.,Universite de Sherbrooke | Fisher C.G.,Blusson Spinal Cord Center
Current Treatment Options in Oncology | Year: 2016

Treatment of primary bone tumours (PBT) of the spine is complex, often involving numerous surgical and oncology disciplines. Surgical en bloc resection with oncologically appropriate margins is the modality of choice when treating malignant PBT. En bloc resection with wide or marginal margins appears to offer better local and systemic control of the disease. This type of surgical resection can also be considered when treating benign aggressive tumours such as aneurysmal bone cyst, giant cell tumour and osteoblastoma. Although these surgeries respect oncologic principles, significant morbidity and mortality are associated. Adverse event collection is highly variable in the literature and mostly from retrospective studies. Wound complication, neurologic deficit and significant blood loss are encountered with surgical resection of PBT of the mobile spine and especially, the sacrum. The adverse event profile of these surgeries is high even in experienced quaternary referral centres. Therefore, primary spinal tumour resection is best performed in experienced centre with adequate multidisciplinary support. Furthermore, prospective and systematic adverse event data collection should be developed to ensure accurate data. The impact of such extensive and potentially impairment producing procedures on health-related quality of life (HRQOL) is another critically valuable piece of information in the era of shared treatment decision making. At the present time, there is paucity of published data regarding HRQOL following these surgeries. Nonetheless, in theory, it seems that health-related quality of life after surgery for PBT is acceptable given the curative intent of the treatment. However, a decision-making process should be tailored to each patient and his or her expectations. Comprehensive discussions should be held preoperatively with the patient, family and other related allied health professionals if the informed consent and decision-making process is to be optimal. © 2016, Springer Science+Business Media New York.

Kwon B.K.,Blusson Spinal Cord Center | Kwon B.K.,University of British Columbia | Okon E.B.,University of British Columbia | Plunet W.,University of British Columbia | And 6 more authors.
Journal of Neurotrauma | Year: 2011

An increasing number of therapies for spinal cord injury (SCI) are emerging from the laboratory and seeking translation into human clinical trials. Many of these are administered as soon as possible after injury with the hope of attenuating secondary damage and maximizing the extent of spared neurologic tissue. In this article, we systematically reviewed the available preclinical research on such neuroprotective therapies that are administered in a non-invasive manner for acute SCI. Specifically, we reviewed treatments that have a relatively high potential for translation due to the fact that they are already used in human clinical applications or are available in a form that could be administered to humans. These included: erythropoietin, NSAIDs, anti-CD11d antibodies, minocycline, progesterone, estrogen, magnesium, riluzole, polyethylene glycol, atorvastatin, inosine, and pioglitazone. The literature was systematically reviewed to examine studies in which an in vivo animal model was utilized to assess the efficacy of the therapy in a traumatic spinal cord injury paradigm. Using these criteria, 122 studies were identified and reviewed in detail. Wide variations exist in the animal species, injury models, and experimental designs reported in the preclinical literature on the therapies reviewed. The review highlights the extent of investigation that has occurred in these specific therapies, and points out gaps in our knowledge that would be potentially valuable prior to human translation. © 2011 Mary Ann Liebert, Inc.

Moore G.R.W.,University of British Columbia | Moore G.R.W.,Pathology and Laboratory Medicine | Moore G.R.W.,Blusson Spinal Cord Center | Laule C.,University of British Columbia
Journal of Neuropathology and Experimental Neurology | Year: 2012

The advent of magnetic resonance imaging (MRI) has revolutionized concepts of the pathogenesis of multiple sclerosis (MS). Magnetic resonance imaging provides the ability to delineate the evolution of the disease process over time; captured static snapshots can then be used in pathologic correlations studies. Certain patterns in the 2-or 3-dimensional MRI sphere correlate very well with similarpatterns of histopathology. A multimodality approach that makes use of numerous MRI techniques can lead to significant insights into the nature of the changes in the CNS. MRI-pathology correlation studies in MS are being performed using newer MRI techniques as they become available. Such correlations and basic histopathologic studies have shown abnormalities in MS far beyond the well-documented changes in the plaque and have brought into question the dogma that MS is an initially inflammatory nondegenerative disease. This review briefly outlines technical considerations in MRI-pathology correlativestudies and describes the past and current status of our ability to correlate focal and diffuse changes on the MRI with neuropathologic findings in MS patients. Copyright © 2012 by the American Association of Neuropathologists, Inc.

Schouten R.,University of British Columbia | Albert T.,Thomas Jefferson University | Kwon B.K.,Blusson Spinal Cord Center
Journal of the American Academy of Orthopaedic Surgeons | Year: 2012

Failure to recognize spinal column or spinal cord injuries, or improper treatment of them, can have catastrophic and often irreversible neurologic consequences. Although the initial assessment is often shared with emergency care personnel, an orthopaedic surgeon's perspective can elevate the priority of spinal care to the level that is warranted. An accurate early appraisal, including complete neurologic assessment, is critical. All aspects of emergent care, including optimal immobilization precautions, resuscitation, and choice of imaging modalities, should be systematically reviewed, and practice guidelines should be adopted by each institution. Increased vigilance is required in patients with underlying ankylosing spinal conditions. The use of CT in the symptomatic patient is established, but the use of cervical MRI in the obtunded individual is contentious. By informing decisions around appropriate preliminary treatment, particularly for persons with neurologic deficits or those at high risk for developing neurologic impairment, long-term outcomes can be optimized.

Ramer L.M.,Kings College London | Ramer L.M.,Blusson Spinal Cord Center | Ramer M.S.,Kings College London | Ramer M.S.,Blusson Spinal Cord Center | And 2 more authors.
The Lancet Neurology | Year: 2014

Spinal cord injury is currently incurable and treatment is limited to minimising secondary complications and maximising residual function by rehabilitation. Improved understanding of the pathophysiology of spinal cord injury and the factors that prevent nerve and tissue repair has fuelled a move towards more ambitious experimental treatments aimed at promoting neuroprotection, axonal regeneration, and neuroplasticity. By necessity, these new options are more invasive. However, in view of recent advances in spinal cord injury research and demand from patients, clinicians, and the scientific community to push promising experimental treatments to the clinic, momentum and optimism exist for the translation of candidate experimental treatments to clinical spinal cord injury. The ability to rescue, reactivate, and rewire spinal systems to restore function after spinal cord injury might soon be within reach. © 2014 Elsevier Ltd.

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