Faculty Bibliography

Spinal cord injury is a devastating condition with no effective treatment. The physiological processes that impede recovery include potentially detrimental immune responses and the production of reactive astrocytes. Previous work suggested that radiation treatment might be beneficial in spinal cord injury, although the method carries risk of radiation-induced damage. To overcome this obstacle we used arrays of parallel, synchrotron-generated X-ray microbeams (230 μm with 150 μm gaps between them) to irradiate an established model of rat spinal cord contusion injury. This technique is known to have a remarkable sparing effect in tissue, including the central nervous system. Injury was induced in adult female Long-Evans rats at the level of the thoracic vertebrae T9-T10 using 25 mm rod drop on an NYU Impactor. Microbeam irradiation was given to groups of 6-8 rats each, at either Day 10 (50 or 60 Gy in-beam entrance doses) or Day 14 (50, 60 or 70 Gy). The control group was comprised of two subgroups: one studied three months before the irradiation experiment (n = 9) and one at the time of the irradiations (n = 7). Hind-limb function was blindly scored with the Basso, Beattie and Bresnahan (BBB) rating scale on a nearly weekly basis. The scores for the rats irradiated at Day 14 post-injury, when using t test with 7-day data-averaging time bins, showed statistically significant improvement at 28-42 days post-injury (P < 0.038). H&E staining, tissue volume measurements and immunohistochemistry at day ≈ 110 post-injury did not reveal obvious differences between the irradiated and nonirradiated injured rats. The same microbeam irradiation of normal rats at 70 Gy in-beam entrance dose caused no behavioral deficits and no histological effects other than minor microglia activation at 110 days. Functional improvement in the 14-day irradiated group might be due to a reduction in populations of immune cells and/or reactive astrocytes, while the Day 10/Day 14 differences may indicate time-sensitive changes in these cells and their populations. With optimizations, including those of the irradiation time(s), microbeam pattern, dose, and perhaps concomitant treatments such as immunological intervention this method may ultimately reach clinical use.

Spinal metastases represent a significant cause of morbidity in patients diagnosed with malignancies. Metastases to the spine can cause severe pain, paralysis, and impairment of activities of daily living. The treatment paradigm for spinal metastases involves a cohesive multidisciplinary approach that allows treatment plans to be made in the context of a patient's overall condition. There have been significant advances in the surgical treatment of spinal metastases that can significantly improve a patient's quality of life.

STUDY DESIGN/METHODS:To use a novel modified intraoperative fluoroscopic view for spinal level localization. OBJECTIVE:To evaluate the safety and utility of the modified oblique fluoroscopic technique for intraoperative localization of distal cervical and proximal thoracic spinal levels. SUMMARY OF BACKGROUND INFORMATION/BACKGROUND:Operative radiographic localization of the cervicothoracic spine using standard anterior-posterior and lateral views is made difficult by its anatomic relationship to the shoulder and upper chest, which produce radiographic shadowing obscuring the spine. Additional image degradation can be caused by muscular patients or those with a high body mass index. An oblique modification of the standard cross table lateral can be used to accurately identify pathologic levels at or across the cervicothoracic junction. This method distinctly demonstrates the bony lamina, which can then be used to count spinal levels. The unique feature of this technique is that the oblique angle removes the shoulder and the majority of the ribs from the active field of view, thereby producing a cleaner and more distinct image. When the gantry angle of the fluoroscope is parallel to the plane of the opposite lamina, it gives a type of "target sign" similar to the trans-pedicular image commonly used in pedicle screw placement. This radiographic sign can be easily identified and recognized across the cervicothoracic junction, even in those patients with a large body mass index or large musculature. METHODS:Spinal level was determined intraoperatively through our oblique technique and confirmed in the same patient through standard views with retrograde counting. Postoperative imaging confirmed correct level surgery. RESULTS:Correct spinal level identification was achieved in the distal cervical and proximal thoracic spine by implementation of our novel oblique fluoroscopy technique. CONCLUSIONS:The modified oblique cross table fluoroscopy technique allows accurate operative localization across the cervicothoracic junction and well into the thoracic spine.

Advances in the treatment of disease and detection through advanced imaging have led to an increase in the discovery of vertebral tumors. Although the majority of symptomatic spinal lesions are metastatic in origin, a significant number of them arise primarily in the spine. These lesions encompass a wide variety of tumor types classified by their cell of origin: bony tumors, cartilaginous tumors, vascular tumors, plasma cell dyscrasias, and tumors that arise from embryonic rests. Further classification of these tumors into malignant or benign subtypes is based on their clinical progression, histopathological evidence of invasiveness, and response to therapy. We provide a brief overview and description of primary tumors as well as treatment paradigms for the individual tumor types. Mt Sinai J Med 76:499-504, 2009. (c) 2009 Mount Sinai School of Medicine.