• Claire F Jones, Peter A Cripton, and Brian K Kwon.
• Orthopaedic and Injury Biomechanics Laboratory, Departments of Mechanical Engineering and Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada. claire.jones@alumni.ubc.ca
• Spine. 2012 Jul 1;37(15):E890-9.

Study DesignQuantitative in vivo ultrasound imaging study of spinal cord and dura morphology after acute experimental spinal cord injury (SCI) and decompression in a pig model.ObjectiveTo study the morphological changes of the spinal cord and dura immediately after surgical decompression for acute SCI.Summary Of Background DataSurgical decompression for traumatic SCI is currently a topic of debate. After decompression, relief of bony impingement on the thecal sac and spinal cord can be confirmed intraoperatively. However, postoperative imaging often reveals that the cord has swollen to fill the subarachnoid space. Little is known about the extent and timing of this morphological response.MethodsYucatan miniature pigs received sham surgery (N = 1) or a moderate (N = 6, 20 g, 2.3 m/s) or high (N = 6, 20 g, 4.7 m/s) severity weight-drop SCI followed by 8 hours of sustained compression (100 g) and 6 hours of postdecompression monitoring. Sagittal-plane ultrasound images were used to quantify spinal cord, dura, and subarachnoid space dimensions preinjury and once per hour after decompression.ResultsAnimals with a moderate SCI exhibited a residual cord deformation of up to 0.64 mm within 10 minutes of decompression, which tended to resolve during 6 hours because of tissue relaxation and swelling. For animals with high-severity SCIs, cord swelling was immediate and resulted in occlusion of the subarachnoid space within 10 minutes to 5 hours, whereas this occurred for only half of the moderate injury group.ConclusionDecompression of an acute SCI may result in residual cord deformation followed by gradual swelling or immediate swelling leading to subarachnoid occlusion. The response is dependent on initial injury severity. These observations may partly explain the lack of benefit of decompression in some patients and suggest a need to reduce cord swelling to optimize the clinical outcome after acute SCI.

26 keywords...

hide…