Mitigating spinal cord distraction injuries: the effect of durotomy in decreasing cord interstitial pressure in vitro

Awwad, Waleed; Bassi, Mahdi; Shrier, Ian; Al-Ahaideb, Abdulaziz; Steele, Russell; Jarzem, Peter

doi:10.1007/s00590-013-1409-5

Cited by 14 publications

(11 citation statements)

References 33 publications

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“… 23 Durotomy also reduced interstitial spinal cord pressure after TSCI in ex vivo pig spinal cords. 24 In rodent models of TSCI, durotomy with duroplasty improves outcome more than durotomy without duroplasty. 25 In rats, durotomy without duroplasty is associated with more macrophage accumulation, cystic cavitation and fibroblast proliferation than durotomy with duroplasty.…”

Section: Discussionmentioning

confidence: 99%

Expansion Duroplasty Improves Intraspinal Pressure, Spinal Cord Perfusion Pressure, and Vascular Pressure Reactivity Index in Patients with Traumatic Spinal Cord Injury: Injured Spinal Cord Pressure Evaluation Study

Phang

Werndle

Saadoun

et al. 2015

Journal of Neurotrauma

129

105

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We recently showed that, after traumatic spinal cord injury (TSCI), laminectomy does not improve intraspinal pressure (ISP), spinal cord perfusion pressure (SCPP), or the vascular pressure reactivity index (sPRx) at the injury site sufficiently because of dural compression. This is an open label, prospective trial comparing combined bony and dural decompression versus laminectomy. Twenty-one patients with acute severe TSCI had re-alignment of the fracture and surgical fixation; 11 had laminectomy alone (laminectomy group) and 10 had laminectomy and duroplasty (laminectomy+duroplasty group). Primary outcomes were magnetic resonance imaging evidence of spinal cord decompression (increase in intradural space, cerebrospinal fluid around the injured cord) and spinal cord physiology (ISP, SCPP, sPRx). The laminectomy and laminectomy+duroplasty groups were well matched. Compared with the laminectomy group, the laminectomy+duroplasty group had greater increase in intradural space at the injury site and more effective decompression of the injured cord. In the laminectomy+duroplasty group, ISP was lower, SCPP higher, and sPRx lower, (i.e., improved vascular pressure reactivity), compared with the laminectomy group. Laminectomy+duroplasty caused cerebrospinal fluid leak that settled with lumbar drain in one patient and pseudomeningocele that resolved completely in five patients. We conclude that, after TSCI, laminectomy+duroplasty improves spinal cord radiological and physiological parameters more effectively than laminectomy alone.

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Section: Discussionmentioning

confidence: 99%

Expansion Duroplasty Improves Intraspinal Pressure, Spinal Cord Perfusion Pressure, and Vascular Pressure Reactivity Index in Patients with Traumatic Spinal Cord Injury: Injured Spinal Cord Pressure Evaluation Study

Phang

Werndle

Saadoun

et al. 2015

Journal of Neurotrauma

129

105

View full text Add to dashboard Cite

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“…In a pig contusion TSCI model, increased thecal sac dimensions were associated with reduced cord compression and reduced injury site ISP [ 28 ]. Durotomy reduced intraparenchymal ISP after TSCI in ex-vivo pig spinal cords [ 29 ]. In a rat contusion TSCI model, durotomy with duroplasty improved outcome more than durotomy without duroplasty [ 27 ].…”

Section: Introductionmentioning

confidence: 99%

Spinal cord injury: is monitoring from the injury site the future?

Saadoun

Papadopoulos

2016

Crit Care

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This paper challenges the current management of acute traumatic spinal cord injury based on our experience with monitoring from the injury site in the neurointensive care unit. We argue that the concept of bony decompression is inadequate. The concept of optimum spinal cord perfusion pressure, which differs between patients, is introduced. Such variability suggests individualized patient treatment. Failing to optimize spinal cord perfusion limits the entry of systemically administered drugs into the injured cord. We conclude that monitoring from the injury site helps optimize management and should be subjected to a trial to determine whether it improves outcome.

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“…Only a few studies have examined durotomy use for the treatment of SCI. The possible mechanisms of the neuroprotective effect of a durotomy are as follows: a decrease in CIP [ 8 ], cavitation, scar formation, and lesional volume [ 9 ]; relief of congestive epidural veins; and restoration of CSF flow [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…These observations suggested that decompression only by removal of osseous and soft-tissue elements might not be adequate and should be further improved to restore normal CIP. Waleed et al found a durotomy could lead to a dramatic CIP drop in a distraction SCI model in vitro [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Intrathecal decompression versus epidural decompression in the treatment of severe spinal cord injury in rat model: a randomized, controlled preclinical research

et al. 2016

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BackgroundIn the setting of severe spinal cord injury (SCI), there is no markedly efficacious clinical therapeutic regimen to improve neurological function. After epidural decompression, as is shown in animal models, the swollen cord against non-elastic dura and elevation of intrathecal pressure may be the main causes of aggravated neurologic function. We performed an intrathecal decompression by longitudinal durotomy to evaluate the neuroprotective effect after severe SCI by comparing with epidural decompression.MethodsEighty-four adult male Sprague-Dawley rats were assigned to three groups: sham group (group S), epidural decompression (group C), and intrathecal decompression group (group D). A weight-drop model was performed at T9. The Basso-Beattie-Bresnahan (BBB) score was used to evaluate neurological function. Animals were sacrificed at corresponding time points, and we performed pathohistological examinations including HE staining and immunohistochemical staining (IHC) of glial fibrillary acidic protein (GFAP), neurocan, and ED1 at the epicenter of injured cords. Finally, the lesions were quantitatively analyzed by SPSS 22.0.ResultsThe mortality rates were, respectively, 5.55 % (2/36) and 13.9 % (5/36) in groups C and D, and there was no significant difference between groups C and D (P = 0.214). Compared with epidural decompression, intrathecal decompression could obviously improve BBB scores after SCI. HE staining indicated that more white matter was spared, and fewer vacuoles and less axon degradation were observed. The expression peak of GFAP, neurocan, and ED1 occurred at an earlier time and was down-regulated in group D compared to group C.ConclusionsOur findings based on rat SCI model suggest that intrathecal decompression by longitudinal durotomy can prompt recovery of neurological function, and this neuroprotective mechanism may be related to the down-regulation of GFAP, neurocan, and ED1.

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Mitigating spinal cord distraction injuries: the effect of durotomy in decreasing cord interstitial pressure in vitro

Abstract: Spinal cord distraction causes elevations in CIP. Durotomy lowers elevated CIP in vitro and may be effective at lowering CIP in vivo. Further study is required to evaluate the usefulness of durotomy in vivo.

Cited by 14 publications

References 33 publications

Expansion Duroplasty Improves Intraspinal Pressure, Spinal Cord Perfusion Pressure, and Vascular Pressure Reactivity Index in Patients with Traumatic Spinal Cord Injury: Injured Spinal Cord Pressure Evaluation Study

Expansion Duroplasty Improves Intraspinal Pressure, Spinal Cord Perfusion Pressure, and Vascular Pressure Reactivity Index in Patients with Traumatic Spinal Cord Injury: Injured Spinal Cord Pressure Evaluation Study

Spinal cord injury: is monitoring from the injury site the future?

Intrathecal decompression versus epidural decompression in the treatment of severe spinal cord injury in rat model: a randomized, controlled preclinical research

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