Background and Objectives: Thoracolumbar fracture–dislocations (AO type C) are rare injuries that occur due to high-energy trauma, and the result is translational and rotational instability of the spinal column and neurological impairment. Several reduction maneuvers have thus far been published, each of which can be of use in certain specific situations. We developed a modification to the previously described reduction technique. Materials and Methods: This is a case study on the management of thoracic AO type C fracture–dislocations managed with a modified reduction technique. The success of the reduction and intraoperative iatrogenic complications such as dural tear and screw pull out were the outcomes analyzed. Results: A total of four cases were successfully reduced with this described reduction technique. We did not note any complications such as a dural tear or screw failure with this modified reduction technique. Conclusions: A modification to the reduction technique employed in the management of thoracic fracture–dislocations resulted in a successful reduction without the risk of iatrogenic complications due to the reduction maneuver.

Adult deformities of the spine, especially in older population, significantly contribute to morbidity of these patients. Although the spectrum of causes is diverse, most often these are newly formed deformations based on degenerative changes of the spine. Apart from pain, feelings of tension and other unpleasant symptoms of adult deformity, they result in biomechanical disorders, reduced mobility, and sometimes neurological deficits. Overall, spinal deformities in adults cause significant disability and poor quality of life (physical and psychological), while on the other hand, they are relatively neglected in everyday practice. Therefore, in this paper we give a narrative review of the latest findings on etiopathogenesis, clinical picture, imaging diagnostics, treatment (conservative and surgical), and postoperative rehabilitation of patients with adult spine deformities of the most common causes.

Recently, marked therapeutic effects pertaining to the recovery of injured rat spinal cords (1 min compression injury of the sacrocaudal spinal cord (S2-Co1) resulting in tail paralysis) appeared after a single intraperitoneal administration of the stable gastric pentadecapeptide BPC 157 at 10 min post-injury. Besides the demonstrated rapid and sustained recovery (1 year), we showed the particular points of the immediate effect of the BPC 157 therapy that began rapidly after its administration, (i) soon after injury (10 min), or (ii) later (4 days), in the rats with a definitive spinal cord injury. Specifically, in counteracting spinal cord hematoma and swelling, (i) in rats that had undergone acute spinal cord injury, followed by intraperitoneal BPC 157 application at 10 min, we focused on the first 10–30 min post-injury period (assessment of gross, microscopic, and gene expression changes). Taking day 4 post-injury as the definitive injury, (ii) we focused on the immediate effects after the BPC 157 intragastric application over 20 min of the post-therapy period. Comparable long-time recovery was noted in treated rats which had definitive tail paralysis: (iii) the therapy was continuously given per orally in drinking water, beginning at day 4 after injury and lasting one month after injury. BPC 157 rats presented only discrete edema and minimal hemorrhage and increased Nos1, Nos2, and Nos3 values (30 min post-injury, (i)) or only mild hemorrhage, and only discrete vacuolation of tissue (day 4, (ii)). In the day 4–30 post-injury study (iii), BPC 157 rats rapidly presented tail function recovery, and no demyelination process (Luxol fast blue staining).

Neck pain is one of the most prevalent musculoskeletal diseases which results in considerable pain and disability, and has a great impact on individual level, as well as on health-care system, and overall society. Causes of neck pain are different, and prevailing aetiology are mechanical reasons associated with degenerative changes of cervical spine. We are witnessing various diagnostic and therapeutic approaches for these patients. The Croatian Society for Vertebrology of the Croatian Medical Association is presenting a comprehensive narrative review and guidelines for the diagnosis and treatment of neck pain, focusing on the most prevalent causes. The guidelines are the result of consensus of experts of different background, based on the best available evidence. Part 1 relates to diagnosis, while the complementary Part 2 relates to treatment. For the diagnostic part (Part 1) the guidelines encompass: clinical features and evaluation (including questionnaires), laboratory tests, imaging, neurophysiology tests, and minimally invasive diagnostic procedures. The management part (Part 2) includes: pharmacology treatment, physical exercise, traction, manual therapies, physical therapy modalities, orthotics, minimally invasive therapeutic interventions, surgical treatment, rehabilitation after surgical procedures, and psychiatric approach. These are the first Croatian guidelines for neck pain intended in the first place for the physicians’ professional community.

Neck pain is one of the most prevalent musculoskeletal diseases which results in considerable pain and disability, and has a great impact on individual level, as well as on health-care system, and overall society. Causes of neck pain are different, and prevailing aetiology are mechanical reasons associated with degenerative changes of cervical spine. We are witnessing various diagnostic and therapeutic approaches for these patients. The Croatian Society for Vertebrology of the Croatian Medical Association is presenting a comprehensive narrative review and guidelines for the diagnosis and treatment of neck pain, focusing on the most prevalent causes. The guidelines are the result of consensus of experts of different background, based on the best available evidence. This part (Part 1) relates to diagnosis, while the complementary part (Part 2) relates to treatment. For the diagnostic part (Part 1) the guidelines encompass: clinical features and evaluation (including questionnaires), laboratory tests, imaging, neurophysiology tests, and minimally invasive diagnostic procedures. The management part (Part 2) includes: pharmacology treatment, physical exercise, traction, manual therapies, physical therapy modalities, orthotics, minimally invasive therapeutic interventions, surgical treatment, rehabilitation after surgical procedures, and psychiatric approach. These are the first Croatian guidelines for neck pain intended in the first place for the physicians’ professional community.

Using a well‐designed rat model, we demonstrated that the stable gastric pentadecapeptide BPC 157 improved the spinal cord injury (FASEB J 2015, 29, 617.5). Previously shown to counteract the consequence of peripheral (sciatic) nerve transection/anastomosis, and improve nerve healing (Regul Pept. 2010 Feb 25;160(1–3):33–41.), and brain trauma (Regul Pept. 2010 Feb 25;160(1–3):26–32.), and various encephalopathies (Curr Pharm Des. 2018;24(18):1990–2001), BPC 157, LD1 not achieved, was implemented as an anti‐ulcer peptide in inflammatory bowel disease trials and now in a multiple sclerosis trial(Curr Pharm Des. 2018;24(18):1990–2001). In a study from the day 1 to 1 year, rats underwent laminectomy (level L2–L3), 60 second compression (neurosurgical piston (60–66 g) on exposed dural sac with sacrocaudal spinal cord) received one medication of BPC 157 (200 or 2 μg/kg) or saline (5 ml/kg)) intraperitoneally at 10 min after injury (FASEB J 2015, 29, 617.5). All injured rats underwent BPC 157 exhibit consistent improvement, clinically, constantly better tail motor function, no autotomy; resolved spasticity already by the day 15; microscopically (since day 7), vacuolas and loss of axons in white matter, edema and loss of motoneurons in gray matter, and decrease of the number of large myelinated axons in rat caudal nerve were largely counteracted in BPC 157 rats. EMG recording evidences markedly lower MUP in tail muscle. Concluding, under the conditions of one single application, given soon after spinal cord injury, counteracted were axonal and neuronal necrosis, demyelination, cyst formation. Now, to create, however, a more reliable situation and therapy effect, the therapy with BPC 157 was started after 4 days. The medication was given in drinking water (BPC 157 10 μg/kg, 0.16 μg/mL, 12 ml/rat/day) through next 4 weeks, while controls received drinking water only. Specifically, tail motor function was scored as follows: 1 ‐ complete loss of tail function; 2 ‐ elevation maximum of 1/4 of tail length; 3 ‐ elevation maximum of 1/2 of tail; 4 ‐ elevation maximum of 3/4 of tail length; 5 – normal function. During evaluation, tail motor function score remained debilitated in rats underwent spinal cord injury that received post‐injury. Contrarily, BPC 157 treated rats exhibited huge improvement, which was continued to full recovery. Conclusion We documented that even given later after injury, the neuroprotective effect of BPC 157 quickly appears, and, BPC 157 given in drinking water, accordingly recovers the failed motor function in rats with spinal cord injury. Support or Funding Information This work was supported by the Ministry of Science, Education and Sports, Republic of Croatia [grant number 108‐1083570‐3635] . This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal .

Uvod. Gigantocelularni arteritis (GCA), još poznat i kao temporalni arteritis, sistemski je vaskulitis velikih i srednje velikih krvnih žila. To je najčešći vaskulitis koji se javlja u osoba starijih od 50 godina. Većina simptoma i znakova GCA-a rezultat su zahvaćanja ekstrakranijalnih ogranaka karotidne arterije. Bolest se javlja dva do četiri puta češće u žena nego u muškaraca. Cilj ovog istraživanja je istražiti učestalost te klinička i laboratorijska obilježja bolesnika s GCA-om liječenih u KBC-u Split. Ispitanici i metode. U istraživanje je uključeno 55 bolesnika s GCA-om koji su liječeni na Zavodu za kliničku imunologiju i reumatologiju KBC-a Split u periodu od 2009. do 2018.godine. Podaci su dobiveni pretraživanjem medicinske dokumentacije. Svi bolesnici zadovoljavali su ACR klasifikacijske kriterije za GCA. Rezultati. Prosječna dob oboljelih bila je 75 godina. Odnos oboljelih žena naspram muškaraca bio je 6:1. Najučestaliji simptom bila je novonastala glavobolja koja se javila u 95 %. Febrilitet/subfebrilitet bio je prisutan u 58%, a gubitak na tjelesnoj težini u 57% bolesnika. Probleme s vidom imalo je 44% ispitanih, a akutni gubitak vida dogodio se u 17% bolesnika. Klaudikacija u području čeljusti bila je prisutna u 26% bolesnika, dok je vertigo bio zabilježen u 22% slučajeva. Simptomi reumatske polimialgije bili su prisutni u 49% ispitanih. Otvrdnuće i zadebljanje temporalne arterije zabilježeno je u 60% bolesnika. U 2 bolesnika verificiran je neoplastični proces (5%). Od laboratorijskih parametara, ubrzana sedimentacija eritrocita je bila prisutna u svih bolesnika. Uočeno je kako se gotovo u polovice bolesnika (45%) bolest javila u zimskim mjesecima. Zaključak. U bolesnika koji se liječe u našem centru uočena je značajnija predominacija ženskog spola u odnosu na podatke iz literature. Klinička i laboratorijska obilježja GCA-a u Dalmaciji slična su izvješćima prethodnih istraživanja, uz nešto veću učestalost novonastale glavobolje, dok je pojavnost bolesti u našem području veća u zimskim mjesecima.

We focused on the therapeutic effects of the stable gastric pentadecapeptide BPC 157 in spinal cord injury using a rat model. BPC 157, of which the LD1 has not been achieved, has been implemented as an anti-ulcer peptide in inflammatory bowel disease trials and recently in a multiple sclerosis trial. In animals, BPC 157 has an anti-inflammatory effect and therapeutic effects in functional recovery and the rescue of somatosensory neurons in the sciatic nerve after transection, upon brain injury after concussive trauma, and in severe encephalopathies. Additionally, BPC 157 affects various molecular pathways. Therefore, BPC 157 therapy was administered by a one-time intraperitoneal injection (BPC 157 (200 or 2 μg/kg) or 0.9% NaCl (5 ml/kg)) 10 min after injury. The injury procedure involved laminectomy (level L2-L3) and a 60-s compression (neurosurgical piston (60–66 g) of the exposed dural sac of the sacrocaudal spinal cord). Assessments were performed at 1, 4, 7, 15, 30, 90, 180, and 360 days after injury. All of the injured rats that received BPC 157 exhibited consistent clinical improvement, increasingly better motor function of the tail, no autotomy, and resolved spasticity by day 15. BPC 157 application largely counteracted changes at the microscopic level, including the formation of vacuoles and the loss of axons in the white matter, the formation of edema and the loss of motoneurons in the gray matter, and a decreased number of large myelinated axons in the rat caudal nerve from day 7. EMG recordings showed a markedly lower motor unit potential in the tail muscle. Axonal and neuronal necrosis, demyelination, and cyst formation were counteracted. The functional rescue provided by BPC 157 after spinal cord injury implies that BPC 157 therapy can impact all stages of the secondary injury phase.

To induce spinal instability, we focused on bilateral facetectomy in rats and possible therapeutic benefit with the stable gastric pentadecapeptide BPC 157 given in the drinking water. Recently, using a well‐designed rat model (L2‐L3 compression), we demonstrated that the stable gastric pentadecapeptide BPC 157 improved the spinal cord injury (FASEB J 2015, 29, 617.5), concluding that under the conditions of one single application, given soon after spinal cord injury, motor function was markedly recovered, axonal and neuronal necrosis was counteracted, as was demyelination and cyst formation. Previously shown to counteract the consequence of peripheral (sciatic) nerve transection/anastomosis, improve nerve healing (Regul Pept. 2010 Feb 25;160(1–3):33–41.), brain trauma (Regul Pept. 2010;160(1–3):26–32.), and various encephalopathies (Curr Pharm Des. 2018;24(18):1990–2001), BPC 157 (LD1 not achieved) was implemented as an anti‐ulcer peptide in inflammatory bowel disease trials and now in a multiple sclerosis trial(Curr Pharm Des. 2018;24(18):1990–2001). In this study, the bilateral paravertebral muscles attached to the L3–L4 segment were peeled from the lumbar spine to expose the posterior bony elements. The rats then underwent complete resection of bilateral L3–L4 facet joints without neural tissue injuries. The medication was given in drinking water (BPC 157 10 ng/kg, 0.16 ng/mL, 12 ml/rat/day) through next 8 weeks, while controls received drinking water only. Radiological assesment of rat spines acquired at 1 week or 8 weeks was conducted (Figure 1). At 1 week, controls and BPC 157 animals exhibited no gross deformity observed in any plane, disk spaces seem unaffected, neural foramen at operated level is slightly widened, though BPC 157 drinking animals had higher bone density overall. At 8 weeks, both groups exhibited no gross deformity observed in any plane, unaffected disk spaces, widened neural foramen at the operated level is slightly widened, though there was an additional discrepancy in bone density overall between groups (BPC 157 having markedly more sclerotic and better defined bones). Also worth noting is the lack of abundant callus formation in the BPC 157 rats whereas the controls have visible callus formation in seemingly random patterns near the affected level. In addition, a significant motor disability which appears in controls immediately upon injury induction, was completely counteracted in BPC 157 drinking rats.Support or Funding InformationThis work was supported by the Ministry of Science, Education and Sports, Republic of Croatia [grant number 108‐1083570‐3635].This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Spinal metastatic disease is a rather common occurrence and definitely warrants attention and treatment due to the high likelihood of leaving cancer patients severely disabled in their final months of life. Recent developments in the understanding of the behavior of different tumor types, as well as advances in surgical treatment, are allowing for the evolution of treatment algorithms, especially when surgical treatment is to be considered. Th is paper gives an overview of the decisionmaking process and the array of surgical options currently available.

Introduction The case report evaluates the clinical and radiological success of early reposition, posterior decompression, posterolateral fusion and stabilization by titanium pedicle screws and rods, performed within six hours after injury in young patient with C-type second lumbar vertebrae (L2) fracture. Material and Methods 22 years old male patient presented in our Clinic with C-type L2 fracture after accident on work site when a part of truck engine felt on his back. The severity of injury was determined using the ASIA (American Spinal Injury Association) scale. Preoperative ASIA impairment scale was evaluated as grade C, with L2 as the most caudal segment with normal motor function. ASIA muscle grading was grade ⅖ evaluated bilaterally on knee extensors, ankle dorsiflexors, long toe extensors and ankle plantar flexors. Patient had voluntary anal contraction and normal anal sensation. ASIA sensory pin prick and light touch scores were in the normal range. Concomitant injuries included transverse process fractures of first, third and fourth lumbar vertebrae (L1, L3, L4) with dislocation, bilateral pneumothorax, fracture of eighth rib on right side and right-sided pulmonary contusion. MSCT showed multifragmentary fracture of anterior and posterior elements of L2 with dislocation and luxation. Preoperative treatment included corticosteroid therapy according to NASCIS III protocol and was continued 3 days postoperatively. Surgery was performed within 6 hours after injury. Reposition of lumbar luxation, posterior decompression, stabilization by titanium pedicle screws and rods and posterolateral fusion with autologous bone graft was done. Postoperatively patient wore a thoracolumbar orthosis for 12 weeks. Physical therapy started second day after surgery and was continued for 12 weeks. Results Patient underwent neurological and radiological evaluation 3 days and 12 weeks postoperatively. MSCT and MR imaging were performed. 3 days postoperatively ASIA impairment scale was grade D, showing neurological recovery on lower limbs with muscle grading ⅘ on knee extensors, ankle dorsiflexors, long toe extensors and ankle plantar flexors. 12 weeks postoperatively ASIA impairment scale remained D but complete motor recovery was noticed on knee extensors and long toe extensors bilaterally. Radiological examinations showed residual dislocation in L1/L2 segment with faset joints subluxation and right-sided foraminal stenosis. 12 weeks postoperatively patient was walking independently with residual motor deficit seen on ankle dorsiflexors and ankle plantar flexors on both legs. Conclusion In young patient with C-type lumbar fracture and incomplete neurological deficit open reposition, posterior decompression, posterolateral fusion and instrumented stabilization is a safe and effective procedure. It is important to involve corticosteroid therapy and to perform a surgery in early phase after traumatic incident. Our results showed that there is a great possibility of neurological recovery if the surgery is performed within 6 hours after injury.

Vertebral artery injuries due to cervical spine trauma, although rarely described in the literature, are relatively common. While most of them will remain asymptomatic, a small percentage of patients may suffer life threatening complications. We report a case of the right vertebral artery injury in a patient with fracture of C4 vertebra, successfully treated with endovascular approach. A 78-year-old male patient was hospitalized for cervical spine injury caused by falling off the tractor. Radiological assessment revealed fracture of C4 vertebra with proximal two-thirds of C4 body dislocated five millimeters dorsally. Significant swelling of soft prevertebral tissues distally of C2 segment was also present. During emergency surgery using standard anterior approach for cervical spine, excessive bleeding started from the injured right vertebral artery. Bleeding was stopped by tamponade with oxidized regenerated cellulose sheet and C4-C5 anterior fixation; then partial reduction of displacement was done. Fifteen days later, after angiography, endovascular repair of the right vertebral artery was performed using percutaneous stent graft. Follow up computed tomography scan angiography showed valid stent patency without contrast extravasation. In cases of cervical spine trauma, surgeon should always be prepared to manage injury of vertebral artery. Bleeding can primarily be stopped by hemostatic packing, and definitive repair can be successfully achieved by endovascular approach using percutaneous stent graft.

Alkaline phosphatase (ALP) and bone-specific alkaline phosphatase (S-bone ALP) activities may serve as markers of the course and rate of bone healing after sustained fractures. The aim of this study was to examine whether the assessment of S-bone ALP as a biochemical parameter in the early posttraumatic phase may indicate the course of fracture healing. To date, the methods used to monitor the bone healing process have been based on the patients' assessment and the radiographic findings. In view of the fact that patient opinion is highly subjective, that the radiographic findings depend on the radiologist's experience and that the monitoring of bone healing is a long-lasting process, measurements of biochemical parameters appear to be the only objective evidence of the changes occurring during bone regeneration. In this study, the activity of bone-specific alkaline phosphatase was measured in the serum of 41 patients who had sustained long bone fractures. The participants included 26 males and 15 females, aged 15 to 80 years. All patients were treated surgically. The activity of S-bone ALP was assessed every seven days over a period of 4 weeks. The study patients were followed up radiologically for several months. Our research showed that the increase of alkaline phosphatase correlated with an increase of S-bone ALP levels. In addition, changes in ALP levels on days 7 and 14 as compared to those on day 1 post injury were associated with changes in S-bone ALP levels on the same day. Likewise, the callus volume correlated with the decrease, no change or increase in the levels of ALP and S-bone ALP in the same way. Based on these results, it may be concluded that monitoring changes in the biochemical parameters alkaline phosphatase and bone-specific alkaline phosphatase allows early detection of fracture healing rates. A minor increase in the activity or no change in the level of the biochemical parameters ALP and S-bone ALP in the period of the first two weeks indicates successful fracture fixation, rapid bone healing and the formation of a minimal or insignificant callus. A major increase in the activity of the biochemical parameters ALP and S-bone ALP in the period of the first two weeks indicates inadequate fracture fixation, delayed bone healing and the formation of a visible and significant callus.