• Marios Papadopoulos.
• Neurosurgery. 2015 Aug 1;62 Suppl 1:224-5.

IntroductionThere is no monitoring from the injured spinal cord to define the optimal values of physiological parameters in ICU. We present a technique for continuously monitoring intraspinal pressure (ISP) and spinal cord perfusion pressure (SCPP).MethodsA pressure probe was placed intradurally at the injury site in 18 patients with severe (AIS A-C) traumatic spinal cord injury (TSCI). ISP monitoring started within 72 hours of the injury and continued for up to a week. Additional probes were inserted to monitor intradural pressure below the injury and extradural pressure. We determined the effect of various maneuvers on spinal cord perfusion pressure (SCPP = mean arterial pressure ISP) and spinal cord function. We also quantified spinal cord vascular reactivity at the injury site (sPRx), as the running correlation coefficient between mean ISP and arterial blood pressure.ResultsThere were no procedure-related complications. ISP at the injury site was higher than intradural pressure below or extradural pressure. Mean ISP from the 18 TSCI patients was higher than mean ISP from 12 subjects without TSCI (20 vs 7 mm Hg, P < .005). Change in arterial pCO2, change in sevoflurane and mannitol administration had no significant effect on ISP or SCPP. Increase in inotropes increased SCPP by 30 mm Hg (P < .005). Laminectomy did not effectively lower ISP. Laminectomy was potentially detrimental by exposing the swollen cord to compression forces applied to the skin. There was a U-shaped relationship between sPRx and SCPP with minimum sPRx at SCPP (SCPPopt) that varied widely between patients (60-120 mm Hg). By increasing SCPP, we could increase the amplitude of MEPs recorded from below or just above the injury level. In cervical AIS C patients, higher SCPP correlated with increased limb motor score.ConclusionISP at the injury site can be measured safely after TSCI. The optimum SCPP varies among TSCI patients.

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