Intraspinal Pressure Monitoring and Extensive Duroplasty in the Acute Phase of Traumatic Spinal Cord Injury: A Systematic Review

Tykocki, Tomasz; Poniatowski, Łukasz A.; Czyż, Marcin; Koziara, Michael; Wynne-Jones, Guy

doi:10.1016/j.wneu.2017.05.138

Cited by 30 publications

(25 citation statements)

References 31 publications

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“…At present there is no consensus about the correct paradigm for managing acute TSCI [2, 3, 37, 38] although there is growing evidence and support for a randomized trial to assess whether novel treatments such as invasive ISP monitoring, SCPP optimization, and expansion duroplasty improve outcomes [39]. …”

Section: Discussionmentioning

confidence: 99%

Predictors of Intraspinal Pressure and Optimal Cord Perfusion Pressure After Traumatic Spinal Cord Injury

et al. 2018

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Background/ObjectivesWe recently developed techniques to monitor intraspinal pressure (ISP) and spinal cord perfusion pressure (SCPP) from the injury site to compute the optimum SCPP (SCPPopt) in patients with acute traumatic spinal cord injury (TSCI). We hypothesized that ISP and SCPPopt can be predicted using clinical factors instead of ISP monitoring.MethodsSixty-four TSCI patients, grades A–C (American spinal injuries association Impairment Scale, AIS), were analyzed. For 24 h after surgery, we monitored ISP and SCPP and computed SCPPopt (SCPP that optimizes pressure reactivity). We studied how well 28 factors correlate with mean ISP or SCPPopt including 7 patient-related, 3 injury-related, 6 management-related, and 12 preoperative MRI-related factors.ResultsAll patients underwent surgery to restore normal spinal alignment within 72 h of injury. Fifty-one percentage had U-shaped sPRx versus SCPP curves, thus allowing SCPPopt to be computed. Thirteen percentage, all AIS grade A or B, had no U-shaped sPRx versus SCPP curves. Thirty-six percentage (22/64) had U-shaped sPRx versus SCPP curves, but the SCPP did not reach the minimum of the curve, and thus, an exact SCPPopt could not be calculated. In total 5/28 factors were associated with lower ISP: older age, excess alcohol consumption, nonconus medullaris injury, expansion duroplasty, and less intraoperative bleeding. In a multivariate logistic regression model, these 5 factors predicted ISP as normal or high with 73% accuracy. Only 2/28 factors correlated with lower SCPPopt: higher mean ISP and conus medullaris injury. In an ordinal multivariate logistic regression model, these 2 factors predicted SCPPopt as low, medium–low, medium–high, or high with only 42% accuracy. No MRI factors correlated with ISP or SCPPopt.ConclusionsElevated ISP can be predicted by clinical factors. Modifiable factors that may lower ISP are: reducing surgical bleeding and performing expansion duroplasty. No factors accurately predict SCPPopt; thus, invasive monitoring remains the only way to estimate SCPPopt.Electronic supplementary materialThe online version of this article (10.1007/s12028-018-0616-7) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Predictors of Intraspinal Pressure and Optimal Cord Perfusion Pressure After Traumatic Spinal Cord Injury

et al. 2018

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“…Epidural venous congestion may reduce the arteriovenous pressure gradient within the cord, decreasing tissue perfusion and promoting ischemia. From their trial, Phang et al showed that the laminectomy plus duroplasty group had a greater increase in the anteroposterior diameter of the dural canal at the injury site and more effective decompression of the injured cord [21]. Qu et al stated that due to the constraint imposed by the vertebral canal and dura, the increase in spinal cord cross section area decreases the volume of the epidural and subarachnoid spaces, blocking the epidural veins, arteriole of the cord, and cerebrospinal fluid (CSF) flow and inducing arachnoid adhesion.…”

Section: Discussionmentioning

confidence: 99%

Method of Decompression by durotomy and duroplasty for cervical spinal cord injury in patients without fracture or dislocation

Telemacque

Zhu

Chen

et al. 2018

Journal of Neurorestoratology

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KEYWORDSspinal cord injury; spinal cord compartment syndrome; decompression; durotomy; spinal cord intramedullary hypertension. Introduction:We developed the method of cervical spinal cord decompression through durotomy followed by duroplasty and analyzed its efficacy. Purpose:To develop a tactic of decompression durotomy and duroplasty for the treatment of severe spinal cord injury(SCI) with extensive edema of the spinal cord and without intramedullary hematoma, and to demonstrate the effectiveness of this method. operations were performed in the cervical spine in patients with SCI. Decompression laminectomy was done without durotomy in the first group of patients. In the second group, duroplasty of the spinal cord was performed after decompression durotomy. A total of 17 patients, 16 males (94%) and 1 female (6%), were operated on (ages from 32 to 66 years). The patients were divided into two groups: a control group and an experimental group. We used the ASIA scale for assessing the patients. The mean follow up time is 12 months (8−24 months). Results:The first group, i.e., the control group consisted of 10 patients who underwent decompression laminectomy without durotomy. The second group, i.e., the experimental group consisted of 7 patients who underwent durotomy followed by duroplasty. In this group, the positive dynamics were observed in 6 patients. Out of 2 patients with ASIA grade "A", one showed improvement to ASIA grade "C", and one improved to ASIA "D". Two patients with ASIA grade "B" showed recovery to ASIA "D". Two patients with ASIA grade "C" improved to grade "D" while one patient showed no change from ASIA "C". Durotomy and duroplasty was effective in the experimental group. Conclusion:The performance of durotomy and duroplasty is an efficient method for the full-scale decompression of the spinal cord and the prevention of edema. This method aims at decreasing intraspinal pressure, as well as preventing ischemia and apoptosis, which is possible for the prevention and treatment of the spinal cord compartment syndrome or spinal cord intramedullary hypertension.

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“…It is important to recognize that MAP support principally aims to maintain an appropriate spinal cord perfusion pressure (SCPP), determined by the difference between MAP and intraspinal pressure (ISP). Since the intraspinal pressure may increase independently of MAP, maintenance of a low ISP or a high SCPP (or both) has gained interest in the initial management of SCI [54][55][56]. Although initial studies have shown encouraging results about the predictive value of low ISP or high SCPP in neurological recovery, larger multicenter studies are needed to validate these preliminary data.…”

Section: Blood Pressure Management After Scimentioning

confidence: 99%

Clinical Trials in Traumatic Spinal Cord Injury

Donovan

Kirshblum

2018

Neurotherapeutics

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Traumatic spinal cord injury (SCI) results in impaired neurologic function that for many individuals is permanent and significantly impacts health, function, quality of life, and life expectancy. Many efforts have been taken to develop effective treatments for SCI; nevertheless, proven therapies targeting neurologic regeneration and functional recovery have been limited. Existing therapeutic approaches, including early surgery, strict blood pressure control, and consideration of treatment with steroids, remain debated and largely focus on mitigating secondary injury after the primary trauma has occurred. Today, there is more research being performed in SCI than ever before. Current clinical trials are exploring pharmacologic, cell-based, physiologic, and rehabilitation approaches to reduce secondary injury and also overcome barriers to neurorecovery. In the future, it is likely that tailored treatments combining many of these strategies will offer significant benefits for persons with SCI. This article aims to review key past, current and emerging neurologic and rehabilitation therapeutic approaches for adults with traumatic SCI.

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Intraspinal Pressure Monitoring and Extensive Duroplasty in the Acute Phase of Traumatic Spinal Cord Injury: A Systematic Review

Cited by 30 publications

References 31 publications

Predictors of Intraspinal Pressure and Optimal Cord Perfusion Pressure After Traumatic Spinal Cord Injury

Predictors of Intraspinal Pressure and Optimal Cord Perfusion Pressure After Traumatic Spinal Cord Injury

Method of Decompression by durotomy and duroplasty for cervical spinal cord injury in patients without fracture or dislocation

Clinical Trials in Traumatic Spinal Cord Injury

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