Role of Early Surgical Decompression of the Intradural Space After Cervical Spinal Cord Injury in an Animal Model

Smith, Jared; Anderson, R.; Pham, Truc Le-Buu; Bhatia, Nitin; Steward, Oswald; Gupta, Ranjan

doi:10.2106/jbjs.i.00740

Cited by 53 publications

(51 citation statements)

References 26 publications

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“…Dimar et al (1999) previously showed that both histological damage and neurological dysfunction increased with incrementally prolonged intraspinal cord compression in a rat model. Smith et al (2010) devised an experiment focusing on intra-dural decompression as a result of the study conducted by Perkins and Deane (1988). Smith et al (2010) hypothesized that performance of a durotomy following acute SCI may abate potential deleterious secondary injury that results from intact dural compression secondary to primary contusive trauma.…”

Section: Discussionmentioning

confidence: 99%

“…It seems intuitive that the effect of surgical decompression of the dura alone would also produce a beneficial outcome. Although the results of the study by Smith et al (2010) showed that durotomy alone may not play a role in acute SCI, further studies must be conducted in order to establish a standardized treatment algorithm and to better understand the progression of disease. Without such knowledge, the potential realization of clinical application of durotomy as a clinically applicable treatment modality is greatly diminished.…”

Section: Discussionmentioning

confidence: 99%

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Surgical decompression in acute spinal cord injury: A review of clinical evidence, animal model studies, and potential future directions of investigation

Walker

Shields

et al. 2014

Front. Biol.

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The goal for treatment in acute spinal cord injury (SCI) is to reduce the extent of secondary damage and facilitate neurologic regeneration and functional recovery. Although multiple studies have investigated potential new therapies for the treatment of acute SCI, outcomes and management protocols aimed at ameliorating neurologic injury in patients remain ineffective. More recent clinical and basic science research have shown surgical interventions to be a potentially valuable modality for treatment; however, the role and timing of surgical decompression, in addition to the optimal surgical intervention, remain one of the most controversial topics pertaining to surgical treatment of acute SCI. As an increasing number of potential treatment modalities emerge, animal models are pivotal for investigating its clinical application and translation into human trials. This review critically appraises the available literature for both clinical and basic science studies to highlight the extent of investigation that has occurred, specific therapies considered, and potential areas for future research.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Surgical decompression in acute spinal cord injury: A review of clinical evidence, animal model studies, and potential future directions of investigation

Walker

Shields

et al. 2014

Front. Biol.

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“…Myelotomy has since been examined in many pre-clinical and clinical studies. 5,6,8,10,11 Previous studies have shown that myelotomy significantly improves functional recovery when compared with opening of the meninges after SCI. 7,12 However, questions are raised regarding application of myelotomy for SCI, such as suitable operation timing.…”

Section: Introductionmentioning

confidence: 99%

Optimal time window of myelotomy in rats with acute traumatic spinal cord injury: a preliminary study

et al. 2013

Spinal Cord

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Objectives: Pathophysiological mechanisms underlying spinal cord injury (SCI) partially involve edema and formation of a hematoma. Myelotomy seems to be a promising intervention. However, the appropriate timing of myelotomy is still unknown in SCI. Here we aimed to determine the timing of microsurgical myelotomy in an animal model of SCI. Methods: The SCI model was contusion-induced with a new york university impactor. Sixty-five adult female rats were randomly divided into the following groups: laminectomy alone (the 'sham group', SG), laminectomy plus contusion (the 'contusion group', CG) or laminectomy plus contusion followed by myelotomy at 8, 24 or 48 h (8 h-MTG [myelotomy-treated group], 24 h-MTG or 48 h-MTG). Functional recovery was evaluated via the open field test and the inclined plane test every week after SCI. The percentage of spared white matter area (SWMA) and ultrastructure characteristics of the injured dorsolateral spinal cord were determined on the 42nd day after SCI. Results: Compared with the CG, myelotomy at 8 h-MTG or 24 h-MTG greatly improved the BASSO-BEATTIE-BRESNAHAN scores (Po0.008), whereas the 48 h-MTG showed less efficacy (P ¼ 0.023). All myelotomy groups showed higher mean angle values in an inclined plane test (Po0.005) and had greater percentages of SWMA than the CG. Rats in the 24 h-MTG showed a higher intraaxonal fraction and myelin fraction than those in 48 h-MTG (Po0.005). Conclusion: Myelotomy up to 48 h after SCI improves recovery in rats. The potential time window of myelotomy may be between 8 and 24 h after SCI.

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“…1,22,24,46,47,53 Cerebral ischemia and elevated ICP cause secondary injury, which can be relieved by surgical decompression. 1,7,10,20,22,24,36,51,53,58,59,61,66 Craniectomy removes compressive elements from the tissue so that the edematous brain swells outward rather than downward, herniation is prevented, and adequate vascular perfusion is maintained. 10 Performing a durotomy in the craniectomy procedure provides the injured brain tissue with a larger space to swell, and the additional space helps to prevent continued mechanical damage to the tissue.…”

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confidence: 99%

Effects of early surgical decompression on functional and histological outcomes after severe experimental thoracic spinal cord injury

Jalan

Saini

Zaidi

et al. 2017

SPI

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OBJECTIVE In acute traumatic brain injury, decompressive craniectomy is a common treatment that involves the removal of bone from the cranium to relieve intracranial pressure. The present study investigated whether neurological function following a severe spinal cord injury improves after utilizing either a durotomy to decompress the intradural space and/or a duraplasty to maintain proper flow of cerebrospinal fluid. METHODS Sixty-four adult female rats (n = 64) were randomly assigned to receive either a 3- or 5-level decompressive laminectomy (Groups A and B), laminectomy + durotomy (Groups C and D), or laminectomy + duraplasty with graft (Group E and F) at 24 hours following a severe thoracic contusion injury (200 kilodynes). Duraplasty involved the use of DuraSeal, a hydrogel dural sealant. Uninjured and injured control groups were included (Groups G, H). Hindlimb locomotor function was assessed by open field locomotor testing (BBB) and CatWalk gait analysis at 35 days postinjury. Bladder function was analyzed and bladder wall thickness was assessed histologically. At 35 days postinjury, mechanical and thermal allodynia were assessed by the Von Frey hair filament and hotplate paw withdrawal tests, respectively. Thereafter, the spinal cords were dissected, examined for gross anomalies at the injury site, and harvested for histological analyses to assess lesion volumes and white matter sparing. ANOVA was used for statistical analyses. RESULTS There was no significant improvement in motor function recovery in any treatment groups compared with injured controls. CatWalk gait analysis indicated a significant decrease in interlimb coordination in Groups B, C, and D (p < 0.05) and swing speed in Groups A, B, and D. Increased mechanical pain sensitivity was observed in Groups A, C, and F (p < 0.05). Rats in Group C also developed thermal pain hypersensitivity. Examination of spinal cords demonstrated increased lesion volumes in Groups C and F and increased white matter sparing in Group E (p < 0.05). The return of bladder automaticity was similar in all groups. Examination of the injury site during tissue harvest revealed that, in some instances, expansion of the hydrogel dural sealant caused compression of the spinal cord. CONCLUSIONS Surgical decompression provided no benefit in terms of neurological improvement in the setting of a severe thoracic spinal cord contusion injury in rats at 24 hours postinjury. Decompressive laminectomy and durotomy did not improve motor function recovery, and rats in both of these treatment modalities developed neuropathic pain. Performing a durotomy also led to increased lesion volumes. Placement of DuraSeal was shown to cause compression in some rats in the duraplasty treatment groups. Decompressive duraplasty of 3 levels does not affect functional outcomes after injury but did increase white matter sparing. Decompressive duraplasty of 5 levels led to neuropathic pain development and increased lesion volumes. Further comparison of dural repair techniques is necessary.

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Role of Early Surgical Decompression of the Intradural Space After Cervical Spinal Cord Injury in an Animal Model

Cited by 53 publications

References 26 publications

Surgical decompression in acute spinal cord injury: A review of clinical evidence, animal model studies, and potential future directions of investigation

Surgical decompression in acute spinal cord injury: A review of clinical evidence, animal model studies, and potential future directions of investigation

Optimal time window of myelotomy in rats with acute traumatic spinal cord injury: a preliminary study

Effects of early surgical decompression on functional and histological outcomes after severe experimental thoracic spinal cord injury

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