• Neurosurgery · Aug 2015

    103 Expansion Duroplasty Improves Intraspinal Pressure, Spinal Cord Perfusion Pressure, and Vascular Pressure Reactivity Index in Patients With Traumatic Spinal Cord Injury.

    • Marios Papadopoulos.
    • Neurosurgery. 2015 Aug 1;62 Suppl 1:197.

    IntroductionWe showed that, after traumatic spinal cord injury (TSCI), the injured cord is compressed by dura. Here, we show that laminectomy + duroplasty decompress the injured cord more effectively than laminectomy alone.MethodsOpen-label, prospective trial. Twenty-one patients with acute, severe TSCI (American Spinal Injury Association Impairment Scale Grades A, B or C) had realignment of the fracture and surgical fixation within 72 hours. Eleven patients had laminectomy (laminectomy group) and 10 had laminectomy and duroplasty (laminectomy + duroplasty group). Primary outcomes were magnetic resonance imaging (MRI) evidence of cord decompression (increase in intradural space, presence of cerebrospinal fluid around the injured cord) and spinal cord physiology (intraspinal pressure [ISP], spinal cord perfusion pressure [SCPP], spinal vascular pressure reactivity index [sPRx]). ISP was monitored from a pressure probe placed intradurally at the injury site, and arterial blood pressure was monitored from a catheter placed in the radial artery. SCPP = mean arterial pressure minus ISP. sPRx is the running correlation coefficient between ISP and arterial blood pressure.ResultsThe 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 (50% vs 20%, P < .05) and more effective decompression of the injured cord (78% vs 0% had MRI CSF signal round the injured cord, P < .01). In the laminectomy + duroplasty group, mean ISP was lower (12.7 vs 18.0 mm Hg, P < .01), mean SCPP higher (83.1 vs 66.8 mm Hg, P < .05) and mean sPRx lower (0.04 vs 0.14, P < .01), ie, improved vascular pressure reactivity, compared with the laminectomy group. Laminectomy + duroplasty caused CSF leak that settled with lumbar drain in 1 patient and pseudomeningocele that resolved completely in 5 patients.ConclusionAfter TSCI, laminectomy + duroplasty improves spinal cord radiological and physiological parameters more effectively than laminectomy.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…