Hypothermia for spinal cord injury

Kwon, Brian K.; Mann, Cody; Sohn, Hong Moon; Hilibrand, Alan S.; Phillips, Frank M.; Wang, Jeffrey C.; Fehlings, Michael G.

doi:10.1016/j.spinee.2007.12.006

Cited by 114 publications

(77 citation statements)

References 89 publications

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“…A combination of isoflurane and the local anesthetic Bupivacaine results in a deeper and more stable anesthesia while permitting an isoflurane dose reduction by a factor of 2-3. Different types of anesthesia have been described for neonatal rodents, including cryoanesthesia 31,32 , but one potential inconvenience of cryoanesthesia is its neuroprotective effect (reviewed by 33,34 ), which could complicate the generation of an efficient and reproducible injury. Barbiturate-based anesthesia is considered to have lower efficiency in neonatal mice due to lower levels of serum albumin and body fat than in adults 35,36 .…”

Section: Discussionmentioning

confidence: 99%

A Neonatal Mouse Spinal Cord Compression Injury Model

Züchner

Glover

Boulland

2016

JoVE

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Spinal cord injury (SCI) typically causes devastating neurological deficits, particularly through damage to fibers descending from the brain to the spinal cord. A major current area of research is focused on the mechanisms of adaptive plasticity that underlie spontaneous or induced functional recovery following SCI. Spontaneous functional recovery is reported to be greater early in life, raising interesting questions about how adaptive plasticity changes as the spinal cord develops. To facilitate investigation of this dynamic, we have developed a SCI model in the neonatal mouse. The model has relevance for pediatric SCI, which is too little studied. Because neural plasticity in the adult involves some of the same mechanisms as neural plasticity in early life 1 , this model may potentially have some relevance also for adult SCI. Here we describe the entire procedure for generating a reproducible spinal cord compression (SCC) injury in the neonatal mouse as early as postnatal (P) day 1. SCC is achieved by performing a laminectomy at a given spinal level (here described at thoracic levels 9-11) and then using a modified Yasargil aneurysm mini-clip to rapidly compress and decompress the spinal cord. As previously described, the injured neonatal mice can be tested for behavioral deficits or sacrificed for ex vivo physiological analysis of synaptic connectivity using electrophysiological and high-throughput optical recording techniques 1 . Earlier and ongoing studies using behavioral and physiological assessment have demonstrated a dramatic, acute impairment of hindlimb motility followed by a complete functional recovery within 2 weeks, and the first evidence of changes in functional circuitry at the level of identified descending synaptic connections 1 .

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Section: Discussionmentioning

confidence: 99%

A Neonatal Mouse Spinal Cord Compression Injury Model

Züchner

Glover

Boulland

2016

JoVE

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“…The vascular surgery literature for thoracoabdominal aortic aneurysm repairs have shown that cooling the epidural space is potentially neuroprotective and safe. 53,77,78 The optimal temperature is not known. However, the use of normal saline chilled to 4°C to cool the epidural space to 25°C has been shown to be effective in minimizing postoperative neurological complications.…”

Section: Treatment Options After An Intraoperative Scimentioning

confidence: 99%

Prevention, identification, and treatment of perioperative spinal cord injury

Ahn¹,

Fehlings

2008

FOC

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Object In this report, the authors suggest evidence-based approaches to minimize the chance of perioperative spinal cord injury (POSCI) and optimize outcome in the event of a POSCI. Methods A systematic review of the basic science and clinical literature is presented. Results Authors of clinical studies have assessed intraoperative monitoring to minimize the chance of POSCI. Furthermore, preoperative factors and intraoperative issues that place patients at increased risk of POSCI have been identified, including developmental stenosis, ankylosing spondylitis, preexisting myelopathy, and severe deformity with spinal cord compromise. However, no studies have assessed methods to optimize outcomes specifically after POSCIs. There are a number of studies focussed on the pathophysiology of SCI and the minimization of secondary damage. These basic science and clinical studies are reviewed, and treatment options outlined in this article. Conclusions There are a number of treatment options, including maintenance of mean arterial blood pressure > 80 mm Hg, starting methylprednisolone treatment preoperatively, and multimodality monitoring to help prevent POSCI occurrence, minimize secondary damage, and potentially improve the clinical outcome of after a POSCI. Further prospective cohort studies are needed to delineate incidence rate, current practice patterns for preventing injury and minimizing the clinical consequences of POSCI, factors that may increase the risk of POSCI, and determinants of clinical outcome in the event of a POSCI.

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“…Modern cooling blankets can be applied and have the advantage of being less invasive but also the disadvantage of being less precise with regards to temperature control. 2 While profound levels of hypothermia (T o32 1C) can be difficult to administer and are subject to increased complication rates, mild (modest) levels of hypothermia (T 32-34 1C) have been shown to provide significant protection against traumatic and ischemic neuronal cell death. 2,3 When administered after experimental acute SCI, there is a reduction in the volume of histopathological damage and a concomitant improvement in BBB walking index.…”

Section: Introductionmentioning

confidence: 99%

“…2 While profound levels of hypothermia (T o32 1C) can be difficult to administer and are subject to increased complication rates, mild (modest) levels of hypothermia (T 32-34 1C) have been shown to provide significant protection against traumatic and ischemic neuronal cell death. 2,3 When administered after experimental acute SCI, there is a reduction in the volume of histopathological damage and a concomitant improvement in BBB walking index. 4,5 A recent study revealed beneficial effect of hypothermia on somato-sensory and motor-evoked potentials.…”

Section: Introductionmentioning

confidence: 99%

Systemic hypothermia in acute cervical spinal cord injury: a case-controlled study

et al. 2012

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Introduction: Systemic hypothermia remains a promising neuroprotective strategy. There has been recent interest in its use in patients with spinal cord injury (SCI). In this article, we describe our extended single center experience using intravascular hypothermia for the treatment of cervical SCI. Methods: Thirty-five acute cervical SCI patients received modest (33 1C) intravascular hypothermia for 48 h. Neurological outcome was assessed by the International Standards for Neurological Classification of Spinal Cord Injury scale (ISNCSCI) developed by the American Spinal Injury Association. Local and systemic complications were recorded. Results: All patients were complete ISNCSCI A on admission, but four converted to ISNCSCI B in o24 h post injury. Hypothermia was delivered in 5.76 ( ± 0.45) hours from injury if we exclude four cases with delayed admission (418 h). Fifteen of total 35 patients (43%) improved at least one ISNCSCI grade at latest follow up 10.07 ( ± 1.03) months. Even excluding those patients who converted from ISNCSCI A within 24 h, 35.5% (11 out of 31) improved at least one ISNCSCI grade. Both retrospective (n ¼ 14) and prospective (n ¼ 21) groups revealed similar number of respiratory complications. The overall risk of any thromboembolic complication was 14.2%. Conclusion:The results are promising in terms of safety and improvement in neurological outcome. To date, the study represents the largest study cohort of cervical SCI patients treated by modest hypothermia. A multi-center, randomized study is needed to determine if systemic hypothermia should be a part of SCI patients' treatment for whom few options exist. Spinal Cord (2013) 51, 395-400; doi:10.1038/sc.2012.161; published online 18 December 2012Keywords: acute cervical SCI; cooling catheter; systemic hypothermia INTRODUCTION Hypothermia continues to show promise in a variety of acute central nervous system injuries. Various factors need to be considered with systemic cooling of the spinal cord injury (SCI) patient, including methods of cooling, window from injury to initiation, duration and depth of hypothermia, and rate of re-warming. Two main methods of spinal cord cooling exist. Local cooling (epidural vs intradural) has a rich history with both experimental and clinical evidence supporting its use. 1 Systemic cooling may be applied either via a transcutaneous or intravascular route. Modern cooling blankets can be applied and have the advantage of being less invasive but also the disadvantage of being less precise with regards to temperature control. 2 While profound levels of hypothermia (T o32 1C) can be difficult to administer and are subject to increased complication rates, mild (modest) levels of hypothermia (T 32-34 1C) have been shown to provide significant protection against traumatic and ischemic neuronal cell death. 2,3 When administered after experimental acute SCI, there is a reduction in the volume of histopathological damage and a concomitant improvement in BBB walking index. 4,5 A recent study revealed beneficial effec...

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Hypothermia for spinal cord injury

Cited by 114 publications

References 89 publications

A Neonatal Mouse Spinal Cord Compression Injury Model

A Neonatal Mouse Spinal Cord Compression Injury Model

Prevention, identification, and treatment of perioperative spinal cord injury

Systemic hypothermia in acute cervical spinal cord injury: a case-controlled study

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