Limits...
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

Outcomes after laminectomy vs. laminectomy+duroplasty at follow-up. (A) Change in American Spinal Injury Association grade (at follow-up minus at presentation). (B) Walking Index for Spinal Cord Injury (WISCI II). (C) Spinal Cord Independence Measure (SCIM III) bladder. (D) SCIM III bowel.
© Copyright Policy - open-access
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4492612&req=5

f6: Outcomes after laminectomy vs. laminectomy+duroplasty at follow-up. (A) Change in American Spinal Injury Association grade (at follow-up minus at presentation). (B) Walking Index for Spinal Cord Injury (WISCI II). (C) Spinal Cord Independence Measure (SCIM III) bladder. (D) SCIM III bowel.

Mentions: Follow-up was 25.8±4.7 months after laminectomy versus 9.4±0.7 months after laminectomy+duroplasty (mean±standard error; p<0.005). In general, all laminectomy+duroplasty patients with incomplete cervical and thoracic spinal cord injuries (ASIA B, C) and some patients with complete cervical spinal cord injuries (ASIA A) on admission improved their ASIA grade at follow-up. No recovery was seen in any of the four laminectomy+duroplasty patients who presented with a complete thoracic spinal cord injury on admission (ASIA A). Change in ASIA grade (ASIA grade at follow-up minus ASIA grade at presentation), walking ability, bladder function, and bowel function were better in the laminectomy+duroplasty versus the laminectomy group, though not significant at p<0.05 (Fig. 6). These data suggest that laminectomy+duroplasty does not cause neurological deterioration in the first few months after surgery.


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)

Outcomes after laminectomy vs. laminectomy+duroplasty at follow-up. (A) Change in American Spinal Injury Association grade (at follow-up minus at presentation). (B) Walking Index for Spinal Cord Injury (WISCI II). (C) Spinal Cord Independence Measure (SCIM III) bladder. (D) SCIM III bowel.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f6: Outcomes after laminectomy vs. laminectomy+duroplasty at follow-up. (A) Change in American Spinal Injury Association grade (at follow-up minus at presentation). (B) Walking Index for Spinal Cord Injury (WISCI II). (C) Spinal Cord Independence Measure (SCIM III) bladder. (D) SCIM III bowel.
Mentions: Follow-up was 25.8±4.7 months after laminectomy versus 9.4±0.7 months after laminectomy+duroplasty (mean±standard error; p<0.005). In general, all laminectomy+duroplasty patients with incomplete cervical and thoracic spinal cord injuries (ASIA B, C) and some patients with complete cervical spinal cord injuries (ASIA A) on admission improved their ASIA grade at follow-up. No recovery was seen in any of the four laminectomy+duroplasty patients who presented with a complete thoracic spinal cord injury on admission (ASIA A). Change in ASIA grade (ASIA grade at follow-up minus ASIA grade at presentation), walking ability, bladder function, and bowel function were better in the laminectomy+duroplasty versus the laminectomy group, though not significant at p<0.05 (Fig. 6). These data suggest that laminectomy+duroplasty does not cause neurological deterioration in the first few months after surgery.

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