Chronic pain after spinal cord injury (SCI) is often refractory to medication, and spinal cord stimulation (SCS) may provide relief. We report a 48-year-old man with complete thoracic SCI who underwent an SCS trial for severe bilateral lower-extremity-pain. Although pain improved, low-grade fever, elevated inflammatory markers, and purulent drainage developed on day 7. Magnetic resonance imaging revealed a spinal epidural abscess (SEA). SCS leads were removed, and cultures grew methicillin-resistant Staphylococcus aureus. As the abscess was small without significant compression, conservative treatment with vancomycin was successful. This case highlights the diagnostic difficulty of SEA in complete SCI.

Spinal cord injury (SCI) causes pathological extracellular matrix (ECM) deposition and tissue stiffening, impeding axonal regeneration and disrupting homeostasis. Galardin-mediated inhibition of matrix metalloproteinases reduces ECM deposition and promotes recovery, but systemic administration fails to adequately address local microenvironment deterioration. We therefore explore a localized biomaterial delivery strategy via regulating the crosslinking degree of hydrogel matrix, in which high-crosslinking density of hydrogel (HCGH) tends to exacerbate neuroinflammation via Piezo1 activation as well as Wwtr1-dependent macrophage reprogramming. Based on this, we fabricate an integrated therapeutic platform where pH-responsive curcumin-succinate self-assembled prodrug nanoparticles (co-loaded with Galardin and basic fibroblast growth factor, denoted as CrS-GF NPs) are encapsulated in a low-crosslinking hydrogel (LCGH). By thorough testing on the compression spinal cord injury model of mice, the LCGH@CrS-GF system not only modulates excessive ECM deposition and neuroinflammation, but also provides sufficient neurotrophic support, thereby facilitating smooth axonal regeneration and functional restoration of the damaged spinal cords in a collaborative manner. Our study highlights the importance of using hydrogels with tailored crosslinking density to deliver therapeutics for SCI repair by stimulating beneficial biological responses and manipulating ECM deposition.

Direct oral anticoagulant (DOAC)-associated spontaneous spinal epidural haematoma (SSEH) is an uncommon but potentially devastating haemorrhagic complication that can cause acute spinal cord compression. Current evidence is limited to case reports, case series, and accompanying narrative reviews, with no comprehensive systematic synthesis of the available evidence. A systematic review was conducted in accordance with PRISMA 2020 guidelines. MEDLINE via PubMed was searched from database inception to March 2026 using predefined search terms, with additional studies identified through backward citation searching. Studies reporting atraumatic SSEH in adults receiving DOACs were included. Traumatic, iatrogenic, and non-epidural haemorrhages were excluded. Data extracted included patient demographics, DOAC type, clinical presentation, diagnostic pathway, management, and neurological outcomes. A descriptive synthesis was performed. A total of 17 studies comprising 21 patients met the inclusion criteria. Rivaroxaban and apixaban were the most frequently implicated DOACs. Patients typically presented with acute neck or back pain followed by rapidly progressive neurological deficits, with several cases initially mimicking acute stroke. MRI was the most frequently utilised imaging modality, while CT also identified the haematoma in several patients, either alone or before subsequent MRI. Management was predominantly surgical decompression, although four patients were managed conservatively. Complete or partial neurological recovery was reported in 18/21 patients. DOAC-associated SSEH is a rare but time-critical neurological emergency. Early recognition, prompt imaging, and timely intervention remain fundamental to optimising neurological outcomes. As the use of DOACs continues to increase, clinician awareness of this uncommon complication is essential to facilitate early diagnosis and appropriate management.

An 84-year-old man had experienced unsteadiness while walking and coldness in both lower limbs for about 18 months, with gradual progression. Neurological examination revealed decreased tendon reflexes in the lower extremities, a positive Romberg sign, and a wide-based gait. MRI demonstrated spinal canal stenosis in the cervical and lumbar regions. Because concomitant peripheral neuropathy was suspected, electrophysiological studies were performed. Nerve conduction studies showed no evidence of peripheral neuropathy. Tibial nerve somatosensory evoked potentials (SEP) revealed prolonged N21-P38 interpeak latency and reduced P38 amplitude, suggesting a predominant central conduction disturbance. Based on these findings, thoracic MRI was performed and revealed the most severe spinal cord compression at the T9/10 level. Discectomy and posterior decompression at this level resulted in improvement of gait. Tibial nerve SEP can be useful for identifying the responsible level in tandem spinal stenosis.

Posterior mediastinal yolk sac tumors (YSTs) with spinal cord compression are exceedingly rare in children. We report a 3-year-old boy with paraplegia due to a posterior mediastinal YST with intraspinal extension. Neoadjuvant chemotherapy followed by surgery led to neurological recovery and long-term remission, highlighting diagnostic and therapeutic challenges.

Neuritin 1 (NRN1) is a neurotrophic factor known to protect neurons from damage and cell death; however, its role and mechanism in cervical spinal cord injury (CSCI) remain unclear. In this study, we investigated the function of NRN1 using oxygen-glucose deprivation (OGD)-treated PC12 cells and a rat model of CSCI established by anterior cervical screw compression. In vitro, NRN1 overexpression promoted neurite outgrowth, attenuated oxidative stress, and inhibited apoptosis in OGD‑exposed PC12 cells, while NRN1 knockdown showed opposite results. Mechanistically, co-immunoprecipitation and immunofluorescence confirmed that NRN1 interacts with FZD2. In OGD-treated PC12 cells, overexpression of FZD2 reversed the neuronal damage induced by NRN1 silencing, reducing oxidative stress and the number of apoptotic cells. Furthermore, NRN1‑mediated neuroprotection was dependent on activation of the GSK‑3β/Nrf2 pathway, since pharmacological inhibition of Nrf2 with ML385 abrogated the protective effects of NRN1. In vivo, decreased expression of NRN1 was observed at the site of spinal cord injury in rats. Notably, intramedullary delivery of adeno‑associated virus (AAV) encoding NRN1 restored NRN1 levels, significantly improved motor function, reduced neuronal apoptosis, and alleviated oxidative stress in spinal cord tissue. Collectively, our findings demonstrate that NRN1 exerts neuroprotective effects against CSCI by binding to FZD2 and activating the GSK‑3β/Nrf2 signaling pathway, suggesting that targeting NRN1 may represent a novel therapeutic strategy for promoting motor recovery in CSCI patients.

Cervical dumbbell schwannomas are rare and heterogeneous tumors with complex surgical management. This single-center retrospective study aimed at evaluating the results of a standardized surgical approach and included patients who underwent surgery for a cervical dumbbell schwannoma between 2013 and 2026. All patients underwent initial posterior extradural intra-radicular surgery without instrumentation. The mean postoperative follow-up was 23.6 months (range: 2-90 months). Among the 26 patients included in the study, 12 had Schwannomatosis. The mean age at surgery was 61 years for sporadic and 37 years for Schwannomatosis patients (p = 0.02, unpaired t-test). The mean tumor volume was 11.9 cm[3] (range: 1.5 - 80 cm[3]). The main indication for surgery was spinal cord compression (19 cases, 73%). Resection via exclusive intraradicular approach was possible in 94% of sporadic and 33% of Schwannomatosis patients (p = 0.03, Fisher's exact test), including 4 cases in which intradural resection was necessary due to a concomitant intradural tumor. Most patients reported an improvement in pain, sensory, and spinal cord compression symptoms, with two cases of worsening symptoms (8.3%). The complete resection rate was 84.6%. Of the four cases with incomplete resection, only one, in a Schwannomatosis patient, required early reoperation. Two cases (8%) of postoperative spinal instability were identified in the series, both in Schwannomatosis patients. Uninstrumented intraradicular resection of dumbbell schwannomas yields satisfactory functional and oncological outcomes in most cases, except for Schwannomatosis patients, diagnosed at a younger age and potentially requiring additional intradural approach for concomitant intracanalar tumors.