The Role of Directly Applied Hypothermia in Spinal Cord Injury

Dimar, John R.; Shields, Christopher B.; Zhang, Yi P.; Burke, Darlene A.; Raque, George H.; Glassman, Steven D.

doi:10.1097/00007632-200009150-00006

Cited by 64 publications

(45 citation statements)

References 28 publications

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“…In the 1960s, local profound hypothermia was produced in some patients by administering cold saline to the exposed spinal cord after laminectomy and during decompression surgeries [45,46]. These studies, along with experimental observations, provided important information regarding the ability to cool locally, and in some cases resulted in functional improvement [19,27,[47][48][49]. However, the interpretation of these studies was complicated by the fact that surgical interventions, including decompression procedures, may have led to some of the beneficial effects that were reported [46].…”

Section: Historical Perspectivementioning

confidence: 99%

“…In studies in which the aorta is clamped for a period of time, hypothermia by epidural perfusion or other strategies of regional and systemic hypothermia have shown some promise in terms of reducing neurological deficits produced by the resulting spinal cord ischemia [65,66]. In contrast to systemic hypothermia, local cooling allows very low levels of hypothermia to be introduced without potentially initiating inherent physiological effects, such as hypotension, bradycardia, and respiratory infection that can be seen in conditions in which systemic hypothermia is used [48,52,67,68]. Nevertheless, a weakness of local cooling is that the procedure cannot be initiated until rather invasive surgical approaches are completed to allow for the application of cold fluid onto the surface of the injured spinal cord.…”

Section: Historical Perspectivementioning

confidence: 99%

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Hypothermic Treatment for Acute Spinal Cord Injury

et al. 2011

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Summary: Spinal cord injury (SCI) is a devastating condition that affects approximately 11,000 patients each year in the United States. Although a significant amount of research has been conducted to clarify the pathophysiology of SCI, there are limited therapeutic interventions that are currently available in the clinic. Moderate hypothermia has been used in a variety of experimental and clinical situations to target several neurological disorders, including traumatic brain and SCI. Recent studies using clinically relevant animal models of SCI have reported the efficacy of therapeutic hypothermia (TH) in terms of promoting long-term behavioral improvement and reducing histopathological damage. In addition, several clinical studies have demonstrated encouraging evidence for the use of TH in patients with a severe cervical spinal cord injury. Moderate hypothermia (33°C) introduced systemically by intravascular cooling strategies appears to be safe and provides some improvement of long-term recovery of function. TH remains an experimental clinical approach and randomized multicenter trials are needed to critically evaluate this potentially exciting therapeutic intervention targeting this patient population.

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Section: Historical Perspectivementioning

confidence: 99%

Section: Historical Perspectivementioning

confidence: 99%

Hypothermic Treatment for Acute Spinal Cord Injury

et al. 2011

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“…Since then, there have been a number of promising experimental animal studies using similar cooling methods [1,3,4,7,9]. Recently, two other successful cooling techniques have been developed, which include using an epidural cooling catheter [34,37,42] and placing a cooling saddle directly onto the spinal cord [12,14,17,18,51]. Despite the promising results in both animal and clinical experimentation, the major disadvantages of these localized cooling protocols are the invasive techniques implemented.…”

Section: Introductionmentioning

confidence: 99%

Theoretical evaluation of a simple cooling pad for inducing hypothermia in the spinal cord following traumatic injury

Smith

Zhu

2009

Med Biol Eng Comput

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The Pennes bioheat equation and finite element method (FEM) are used to solve for the temperature distributions in the spinal cord and cerebrospinal fluid (CSF) during 30 min of cooling for spinal cord injury (SCI) patients. The average CSF and spinal cord temperatures are reduced by 3.48 and 2.72 degrees C, respectively. The 100-mm wide pad provides the desired cooling and uses the least amount of material. The presence of zero-average CSF oscillation under normal conditions decreases the cooling extent in the spinal cord due to the introduction of warm CSF surrounding the spinal cord. The temperature decrease in the spinal cord is more than doubled when the temperature at the back of the torso is lowered from 20 to 0 degrees C. Spinal cord ischemia, often observed after traumatic spinal cord injury, promotes cooling penetration. The proposed technique can reduce the spinal cord temperature by 2 degrees C within 30 min and may be a feasible treatment for traumatic SCI.

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“…Although several studies showed improved neurological outcomes, subsequent studies resulted in contrasting findings [5,6]. Malone dialdehyde (MDA) and GSH-Px levels are indicators of lipid peroxidation [7].…”

Section: Introductionmentioning

confidence: 99%

Does Hypothermic Treatment Provide an Advantage After Spinal Cord Injury Until Surgery? An Experimental Study

et al. 2008

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We compared the effects of early and late stage hypothermia treatment after spinal cord injury. Five groups each consisting of seven rats were included in this study. In Group 1a (Clip applied-non-treatment group) and Group 1b (Clip applied-treated group) the spinal cords were harvested 1 h after the injury. In Group 2a (clip applied, non-treated group) and Group 2b (clip applied-treated group) the injured segments were harvested 24 h after injury. Group 3 was designed as the sham-operated group. The significantly lower levels of TBARS and GSH-Px in Group 2a, as compared with Group 1b suggests that the hypothermia was effective in the early stage of treatment (P < 0.05). In contrast, TBARS and GSH-Px levels were significantly increased at the 24 h timepoint following treatment (P < 0.05). Short-term systemic hypothermia reduces lipid peroxidation in the early stages after spinal cord injury. This beneficial effect disappears 24 h following systemic hypothermic treatment.

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The Role of Directly Applied Hypothermia in Spinal Cord Injury

Cited by 64 publications

References 28 publications

Hypothermic Treatment for Acute Spinal Cord Injury

Hypothermic Treatment for Acute Spinal Cord Injury

Theoretical evaluation of a simple cooling pad for inducing hypothermia in the spinal cord following traumatic injury

Does Hypothermic Treatment Provide an Advantage After Spinal Cord Injury Until Surgery? An Experimental Study

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