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Expansion duroplasty improves intraspinal pressure, spinal cord perfusion pressure, and vascular pressure reactivity index in patients with traumatic spinal cord injury: injured spinal cord pressure evaluation study.

Phang I, Werndle MC, Saadoun S, Varsos G, Czosnyka M, Zoumprouli A, Papadopoulos MC - J. Neurotrauma (2015)

Bottom Line: Compared with the laminectomy group, the laminectomy+duroplasty group had greater increase in intradural space at the injury site and more effective decompression of the injured cord.In the laminectomy+duroplasty group, ISP was lower, SCPP higher, and sPRx lower, (i.e., improved vascular pressure reactivity), compared with the laminectomy group.Laminectomy+duroplasty caused cerebrospinal fluid leak that settled with lumbar drain in one patient and pseudomeningocele that resolved completely in five patients.

View Article: PubMed Central - PubMed

Affiliation: 1 Academic Neurosurgery Unit, St. George's University of London , United Kingdom .

ABSTRACT
We recently showed that, after traumatic spinal cord injury (TSCI), laminectomy does not improve intraspinal pressure (ISP), spinal cord perfusion pressure (SCPP), or the vascular pressure reactivity index (sPRx) at the injury site sufficiently because of dural compression. This is an open label, prospective trial comparing combined bony and dural decompression versus laminectomy. Twenty-one patients with acute severe TSCI had re-alignment of the fracture and surgical fixation; 11 had laminectomy alone (laminectomy group) and 10 had laminectomy and duroplasty (laminectomy+duroplasty group). Primary outcomes were magnetic resonance imaging evidence of spinal cord decompression (increase in intradural space, cerebrospinal fluid around the injured cord) and spinal cord physiology (ISP, SCPP, sPRx). The 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 and more effective decompression of the injured cord. In the laminectomy+duroplasty group, ISP was lower, SCPP higher, and sPRx lower, (i.e., improved vascular pressure reactivity), compared with the laminectomy group. Laminectomy+duroplasty caused cerebrospinal fluid leak that settled with lumbar drain in one patient and pseudomeningocele that resolved completely in five patients. We conclude that, after TSCI, laminectomy+duroplasty improves spinal cord radiological and physiological parameters more effectively than laminectomy alone.

No MeSH data available.


Related in: MedlinePlus

Intraspinal pressure (ISP) and spinal cord perfusion pressure (SCPP). (A) Representative ISP waveform showing percussion (P1), tidal (P2) and dicrotic (P3) peaks. (B) Mean four-hourly ISP of laminectomy, and laminectomy+duroplasty patients. (C) Cumulative frequency curve of ISP. (D) Mean four-hourly SCPP of laminectomy and duroplasty patients. (E) Cumulative frequency curve of SCPP. Laminectomy (open circles, n=11); laminectomy+duroplasty (closed circles, n=9), Mean±standard error. LAM, laminectomy; LAMI+DURO, laminectomy+duroplasty. p<0.05*, 0.01**.
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f3: Intraspinal pressure (ISP) and spinal cord perfusion pressure (SCPP). (A) Representative ISP waveform showing percussion (P1), tidal (P2) and dicrotic (P3) peaks. (B) Mean four-hourly ISP of laminectomy, and laminectomy+duroplasty patients. (C) Cumulative frequency curve of ISP. (D) Mean four-hourly SCPP of laminectomy and duroplasty patients. (E) Cumulative frequency curve of SCPP. Laminectomy (open circles, n=11); laminectomy+duroplasty (closed circles, n=9), Mean±standard error. LAM, laminectomy; LAMI+DURO, laminectomy+duroplasty. p<0.05*, 0.01**.

Mentions: ISP recordings were taken from 11/11 laminectomy patients and 9/10 laminectomy+duroplasty patients. In one laminectomy+duroplasty patient, the probe was dislodged into the paraspinal muscles at Day 1. The period of ISP recording was comparable in the laminectomy and laminectomy+duroplasty groups (Table 1). The ISP waveform was remarkably similar to the ICP waveform with percussion, tidal, and dicrotic peaks (Fig. 3A). Plot of four-hourly mean ISP against time showed that ISP was lower in the laminectomy+duroplasty versus laminectomy group (overall mean±standard error 12.7±0.4 vs. 18.0±0.5 mm Hg; p<0.01; Fig. 3B). Compared with laminectomy, laminectomy+duroplasty caused a significant left-shift of the ISP cumulative frequency curve (Fig. 3C). This indicates that more time is spent at a lower ISP after laminectomy+duroplasty versus laminectomy. Figure 3D shows the four-hourly mean SCPP plotted against time. SCPP after laminectomy+duroplasty was higher than after laminectomy (overall mean±standard error, 83.1±1.1 mm Hg vs. 66.8±1.3; p<0.05). Compared with laminectomy, laminectomy+duroplasty caused a significant right-shift of the SCPP cumulative frequency curve (Fig. 3E). This indicates that more time is spent at a higher SCPP after laminectomy+duroplasty versus laminectomy.


Expansion duroplasty improves intraspinal pressure, spinal cord perfusion pressure, and vascular pressure reactivity index in patients with traumatic spinal cord injury: injured spinal cord pressure evaluation study.

Phang I, Werndle MC, Saadoun S, Varsos G, Czosnyka M, Zoumprouli A, Papadopoulos MC - J. Neurotrauma (2015)

Intraspinal pressure (ISP) and spinal cord perfusion pressure (SCPP). (A) Representative ISP waveform showing percussion (P1), tidal (P2) and dicrotic (P3) peaks. (B) Mean four-hourly ISP of laminectomy, and laminectomy+duroplasty patients. (C) Cumulative frequency curve of ISP. (D) Mean four-hourly SCPP of laminectomy and duroplasty patients. (E) Cumulative frequency curve of SCPP. Laminectomy (open circles, n=11); laminectomy+duroplasty (closed circles, n=9), Mean±standard error. LAM, laminectomy; LAMI+DURO, laminectomy+duroplasty. p<0.05*, 0.01**.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4492612&req=5

f3: Intraspinal pressure (ISP) and spinal cord perfusion pressure (SCPP). (A) Representative ISP waveform showing percussion (P1), tidal (P2) and dicrotic (P3) peaks. (B) Mean four-hourly ISP of laminectomy, and laminectomy+duroplasty patients. (C) Cumulative frequency curve of ISP. (D) Mean four-hourly SCPP of laminectomy and duroplasty patients. (E) Cumulative frequency curve of SCPP. Laminectomy (open circles, n=11); laminectomy+duroplasty (closed circles, n=9), Mean±standard error. LAM, laminectomy; LAMI+DURO, laminectomy+duroplasty. p<0.05*, 0.01**.
Mentions: ISP recordings were taken from 11/11 laminectomy patients and 9/10 laminectomy+duroplasty patients. In one laminectomy+duroplasty patient, the probe was dislodged into the paraspinal muscles at Day 1. The period of ISP recording was comparable in the laminectomy and laminectomy+duroplasty groups (Table 1). The ISP waveform was remarkably similar to the ICP waveform with percussion, tidal, and dicrotic peaks (Fig. 3A). Plot of four-hourly mean ISP against time showed that ISP was lower in the laminectomy+duroplasty versus laminectomy group (overall mean±standard error 12.7±0.4 vs. 18.0±0.5 mm Hg; p<0.01; Fig. 3B). Compared with laminectomy, laminectomy+duroplasty caused a significant left-shift of the ISP cumulative frequency curve (Fig. 3C). This indicates that more time is spent at a lower ISP after laminectomy+duroplasty versus laminectomy. Figure 3D shows the four-hourly mean SCPP plotted against time. SCPP after laminectomy+duroplasty was higher than after laminectomy (overall mean±standard error, 83.1±1.1 mm Hg vs. 66.8±1.3; p<0.05). Compared with laminectomy, laminectomy+duroplasty caused a significant right-shift of the SCPP cumulative frequency curve (Fig. 3E). This indicates that more time is spent at a higher SCPP after laminectomy+duroplasty versus laminectomy.

Bottom Line: Compared with the laminectomy group, the laminectomy+duroplasty group had greater increase in intradural space at the injury site and more effective decompression of the injured cord.In the laminectomy+duroplasty group, ISP was lower, SCPP higher, and sPRx lower, (i.e., improved vascular pressure reactivity), compared with the laminectomy group.Laminectomy+duroplasty caused cerebrospinal fluid leak that settled with lumbar drain in one patient and pseudomeningocele that resolved completely in five patients.

View Article: PubMed Central - PubMed

Affiliation: 1 Academic Neurosurgery Unit, St. George's University of London , United Kingdom .

ABSTRACT
We recently showed that, after traumatic spinal cord injury (TSCI), laminectomy does not improve intraspinal pressure (ISP), spinal cord perfusion pressure (SCPP), or the vascular pressure reactivity index (sPRx) at the injury site sufficiently because of dural compression. This is an open label, prospective trial comparing combined bony and dural decompression versus laminectomy. Twenty-one patients with acute severe TSCI had re-alignment of the fracture and surgical fixation; 11 had laminectomy alone (laminectomy group) and 10 had laminectomy and duroplasty (laminectomy+duroplasty group). Primary outcomes were magnetic resonance imaging evidence of spinal cord decompression (increase in intradural space, cerebrospinal fluid around the injured cord) and spinal cord physiology (ISP, SCPP, sPRx). The 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 and more effective decompression of the injured cord. In the laminectomy+duroplasty group, ISP was lower, SCPP higher, and sPRx lower, (i.e., improved vascular pressure reactivity), compared with the laminectomy group. Laminectomy+duroplasty caused cerebrospinal fluid leak that settled with lumbar drain in one patient and pseudomeningocele that resolved completely in five patients. We conclude that, after TSCI, laminectomy+duroplasty improves spinal cord radiological and physiological parameters more effectively than laminectomy alone.

No MeSH data available.


Related in: MedlinePlus