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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: 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.

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) in supine vs. lateral patient position after laminectomy+duroplasty. (A) Representative ISP and corresponding SCPP recorded from a patient lying supine or laterally (i.e., lying on left or right side). Recorded signal (gray line), mean (black line). (B) Mean daily difference between supine and side positions for ISP (ISPsup – ISPlat) and SCPP (SCPPsup – SCPPlat) plotted against days since surgery. n=9; mean±standard error.
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f5: Intraspinal pressure (ISP) and spinal cord perfusion pressure (SCPP) in supine vs. lateral patient position after laminectomy+duroplasty. (A) Representative ISP and corresponding SCPP recorded from a patient lying supine or laterally (i.e., lying on left or right side). Recorded signal (gray line), mean (black line). (B) Mean daily difference between supine and side positions for ISP (ISPsup – ISPlat) and SCPP (SCPPsup – SCPPlat) plotted against days since surgery. n=9; mean±standard error.

Mentions: We hypothesized that duroplasty exposes the injured spinal cord to compression forces applied to the wound. This suggests that ISP may rise in the supine versus lateral position in bed. Figure 5A shows representative ISP and SCPP signals from a patient with a thoracic spinal cord injury that had duroplasty lying in different positions. In this patient, lying supine was associated with higher ISP and lower SCPP, compared with lying laterally. The difference in ISP between the supine and lateral positions averaged over 24 h (ISPsup – ISPlat) and corresponding difference in SCPP (SCPPsup – SCPPlat) for the laminectomy+duroplasty patient group were plotted against time (Fig. 5B). Lying supine versus laterally caused, on average, a rise in ISP by ∼ 2 mm Hg in the first 4 d after surgery with a corresponding fall in SCPP. The maximum ISPsup – ISPlat observed in a patient was ∼7 mm Hg and the minimum SCPPsup – SCPPlat was−11 mm Hg. Together, our data show that lying supine produces a small increase in ISP and a small decrease in SCPP. In some patients these changes may be large enough to be clinically significant.


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) in supine vs. lateral patient position after laminectomy+duroplasty. (A) Representative ISP and corresponding SCPP recorded from a patient lying supine or laterally (i.e., lying on left or right side). Recorded signal (gray line), mean (black line). (B) Mean daily difference between supine and side positions for ISP (ISPsup – ISPlat) and SCPP (SCPPsup – SCPPlat) plotted against days since surgery. n=9; mean±standard error.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f5: Intraspinal pressure (ISP) and spinal cord perfusion pressure (SCPP) in supine vs. lateral patient position after laminectomy+duroplasty. (A) Representative ISP and corresponding SCPP recorded from a patient lying supine or laterally (i.e., lying on left or right side). Recorded signal (gray line), mean (black line). (B) Mean daily difference between supine and side positions for ISP (ISPsup – ISPlat) and SCPP (SCPPsup – SCPPlat) plotted against days since surgery. n=9; mean±standard error.
Mentions: We hypothesized that duroplasty exposes the injured spinal cord to compression forces applied to the wound. This suggests that ISP may rise in the supine versus lateral position in bed. Figure 5A shows representative ISP and SCPP signals from a patient with a thoracic spinal cord injury that had duroplasty lying in different positions. In this patient, lying supine was associated with higher ISP and lower SCPP, compared with lying laterally. The difference in ISP between the supine and lateral positions averaged over 24 h (ISPsup – ISPlat) and corresponding difference in SCPP (SCPPsup – SCPPlat) for the laminectomy+duroplasty patient group were plotted against time (Fig. 5B). Lying supine versus laterally caused, on average, a rise in ISP by ∼ 2 mm Hg in the first 4 d after surgery with a corresponding fall in SCPP. The maximum ISPsup – ISPlat observed in a patient was ∼7 mm Hg and the minimum SCPPsup – SCPPlat was−11 mm Hg. Together, our data show that lying supine produces a small increase in ISP and a small decrease in SCPP. In some patients these changes may be large enough to be clinically significant.

Bottom Line: 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.

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