Early durotomy with duroplasty for severe adult spinal cord injury without radiographic abnormality: a novel concept and method of surgical decompression

Abstract

Purpose Treatment options for adult spinal cord injury without radiographic abnormality (ASCIWORA) varied. Compression of ASCIWORA may more likely result from spinal cord lesions such as edema and hemorrhage or contusion. This study aimed to explore the clinical effect of early durotomy with duroplasty decompression in the treatment of severe ASCIWORA. Methods Data of 16 patients with ASCIWORA who underwent early (< 72 h) posterior laminectomy followed by durotomy with duroplasty decompression from June 2015 to January 2017 were retrospectively analyzed. Patients' prognosis was analyzed by American Spinal Injury Association Impairment Scale (AIS) grades and scores. In 3 patients, intraspinal pressure (ISP) was continuously monitored for 1 week. Results Cervical magnetic resonance imaging (MRI) revealed spinal cord edema in 9 patients and suspected hemorrhage or contusion in 7 cases. Pathological manifestations of spinal cord injury found during the operation were consistent with preoperative MRI findings. Of the 16 cases, AIS grade was improved by 1 grade in 3 cases, 2 grades in 11 cases, and 3 grades in 1 case. The AIS scores at the last follow-up were significantly higher than preoperative scores. There was a high level of ISP after laminectomy, whereas ISP continued to decrease steadily after durotomy. Conclusions Durotomy helps thoroughly decompress the spinal cord and improve cerebrospinal fluid circulation in severe ASCI-WORA cases. Cervical MRI and pathological investigation of the spinal cord can be used to evaluate and predict the prognosis of ASCIWORA patients. ISP monitoring is an effective method for evaluating intramedullary pressure and decompression.

Clinical diagnosis and treatment of spinal cord injury without evidence of abnormality in children: a review

“…In adults, many studies suggest the use of posterior laminectomy followed by durotomy with duraplasty, which is an effective method of decreasing intraspinal pressure and improving blood circulation at the swollen cord. [34][35][36][37] Decreasing the pressure at the injury site helps to increase the blood flow, avoid further injury, which can relive cord oedema, and prevent the progress of spinal cord compartment syndrome. Therefore, treating the compartment syndrome depends on opening all the structures to reduce the pressure at the injury site.…”

Nursing Care of a Patient with Cervical Spinal Cord Injury Without Fracture and Dislocation: A Case Report

“…The international concept is equivalent to cervical spinal cord injury without radiographic abnormality (CSCIWORA), which is a special type of cervical spinal cord injury. It accounts for 9%~14% of adult spinal cord injuries [1], but the actual incidence is underestimated [2,3]. Degenerative disc herniation, vertebral bone hyperplasia, hypertrophy of the yellow ligament, or ossification of the posterior longitudinal ligament cause cervical spinal stenosis and spinal cord compression [4].…”

Early and short-segment anterior spinal fusion for cervical spinal cord injury without fracture and dislocation can achieve more significant neurological recovery: a retrospective study based on the current medical system in southern China

“…In recent years, with the development of transportation and aerial work, increasing numbers of patients have suffered from traumatic cervical spinal cord injury (SCI). As one form of traumatic cervical SCI, the incidence of cervical spinal cord injury without fracture and dislocation (CSCIWFD) in adults is very high due to preexisting cervical degeneration and that the actual rate is underestimated [1, 2]. Trauma is a major cause of CSCIWFD.…”

“…For these patients, conservative treatment is the main option, but problems such as a long treatment cycle, a high complication rate, high mortality, and long-term functional decline are common [4, 5]. Therefore, most clinicians prefer early surgical intervention [2]. Current studies indicate that changes in cervical spinal cord signals on cervical magnetic resonance imaging (MRI) strongly indicate that surgical treatment is required [6].…”

“…For patients with CSCIWFD, anterior cervical decompression and fusion (ACDF) is mainly performed to explore the ruptured disc, remove the compressed tissue anterior to the spinal cord, reconstruct the cervical spine, and provide conditions for spinal cord functional recovery and cervical segment stabilization. However, no consensus has been reached regarding the effects of the number of fused segments on postoperative efficacy and adjacent segment degeneration (ASD) [8] or the optimal surgical timing [2, 9, 10] in the academic community.…”