Elevated intraspinal pressure in traumatic spinal cord injury is a promising therapeutic target

Yang, Chaohua; Quan, Zhengxue; Wang, Gao-Ju; He, Tao; Chen, Zhiyu; Li, Qiaochu; Yang, Jing; Wang, Qing

doi:10.4103/1673-5374.332203

Cited by 14 publications

(22 citation statements)

References 109 publications

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“…Timely decompression can prevent and reduce secondary injury. The earlier the surgical decompression, the better the prognosis of patients with spinal cord injury [ 19 – 22 ]. (3) Transportation and protection before admission: the spinal cord without protection from the spinal column may be compressed and stretched if no proper protection is given during the transportation to the hospital.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Patients with Cervical Spinal Cord Injury Treated by Surgery and Their Prognostic Factors

Song

Jin

et al. 2022

Applied Bionics and Biomechanics

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Objective. To investigate the outcomes of patients with cervical spinal cord injury treated by surgery and their prognostic factors. Methods. We retrospectively analyzed 139 patients with cervical spinal cord injury treated by surgery at our hospital, who were admitted between January 2017 and December 2018. Depending on the Barthel index at last follow-up, the patients were divided into the recovery group ( n = 60 , Barthel index > 45 ) and the nonrecovery group ( n = 79 , Barthel index ≤ 45 ). General information of patients in the two groups was compared. The significant factors were further introduced into the logistic regression model. The poor prognostic factors of cervical spinal cord injury treated by surgery were analyzed, and specific nursing measures were taken. Results. There were significant differences in the duration of injury before admission, duration of injury before surgery, transportation and protection before admission, spinal canal invasion rate, and hormonal therapy within 8 h after injury between the patients achieving good postoperative recovery and those not ( P < 0.05 ). Logistic regression analysis showed that all the factors above were prognostic factors for cervical spinal cord injury treated surgically. Conclusion. The duration of injury before admission, duration of injury before surgery, transportation and protection before admission, spinal canal invasion rate, and hormonal therapy within 8 h after injury were prognostic factors of patients with cervical spinal cord injury treated by surgery. The following factors should be considered for favorable outcomes: spinal protection during transportation to hospital, timely hormonal shock therapy to delay injury progression, and timely surgery to relieve pain. The spine is composed of cervical, thoracic, lumbar, sacral, and caudal vertebrae.

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Section: Discussionmentioning

confidence: 99%

Outcomes of Patients with Cervical Spinal Cord Injury Treated by Surgery and Their Prognostic Factors

Song

Jin

et al. 2022

Applied Bionics and Biomechanics

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“…This notable neurological recovery is consistent with previous studies. This result might be explained by early surgical decompression expeditiously relieving mechanical spinal cord compression, thereby improving the spinal cord blood supply to avoid or mitigate secondary damage cascades and SCHS and to facilitate the restoration of spinal cord function (2,22,29). Badhiwala and colleagues stated that "time is spine" (30) and highlighted that there is a critical time window after primary injury to the spinal cord during which secondary injury mechanisms, which cause further neural tissue destruction, may be curtailed (31).…”

Section: Discussionmentioning

confidence: 99%

“…The higher odds of achieving an improvement in the AIS grade of at least a one grade in our study than in Jug's study might be due to the difference in the surgical method used for decompression; extensive posterior laminoplasty (assisted with posterior pedicle screw fixation if necessary) was performed in our study, whereas anterior discectomy (ADF) or corpectomy (ACF) and fusion was preferred in Jug's study. Obviously, more adequate decompression increases the possibility of upward AIS grade conversion (2,7,18). In a recent study, Piazza reported that posterior cervical laminectomy results in better radiological decompression of the posterior CSF space than does ADF (11).…”

Section: Discussionmentioning

confidence: 99%

“…The cervical spinal cord is the most frequently affected segment in traumatic spinal cord injury (SCI), potentially leading to quadriplegia, lifelong disabling neurological sequelae and even death (1). Studies have shown that SCI can be divided into primary and secondary injury according to different injury stages and pathophysiological mechanisms (2). The primary goal in treatment is to maximize the improvement of spinal cord function and the extent of spinal cord decompression, attenuate secondary injury, and stabilize the spine (3).…”

Section: Introductionmentioning

confidence: 99%

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Early expansive single sided laminoplasty decompression treatment severe traumatic cervical spinal cord injury

Yang

Wang

et al. 2022

Front. Surg.

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Background: Severe traumatic cervical spinal cord injury (tcSCI) is a disastrous event for patients and families. Maximizing spinal cord function recovery has become the primary therapeutic goal. This study investigated the effect of early extensive posterior decompression on spinal cord function improvement after severe tcSCI. Methods: A retrospective review of 83 consecutive patients who underwent extensive open-door laminoplasty decompression within 24 h after severe tcSCI (American Spinal Injury Association (ASIA) impairment scale (AIS) grade A to C) between 2009 and 2017 at our institution was performed. The patient clinical and demographic data were collected. Neurological functional recovery was evaluated according to the Japanese Orthopaedic Association (JOA) score system, ASIA motor score (AMS) and AIS grade. Results: Among the 83 patients initially included, the baseline AIS grade was A in 12, B in 28, and C in 43. Twenty-three patients (27.7%) had a high cervical injury. Cervical spinal stenosis (CSS) was identified in 37 patients (44.6%). The mean intramedullary lesion length was 59.6 ± 20.4 mm preoperatively and 34.2 ± 13.3 mm postoperatively ( p < 0.0001). At the final follow-up visit, an improvement of at least one and two AIS grades was found in 75 (90.4%) and 41 (49.4%) patients, respectively. 24 (64.9%) patients with an improvement of least two AIS grades had CSS. The mean AMS and JOA score were significantly improved at discharge and the final follow-up visit compared with on admission ( p < 0.0001). Conclusions: Our results suggest that early expansive laminoplasty decompression may improve neurological outcomes after severe tcSCI, especially in patients with CSS. Larger and prospective controlled studies are needed to validate these findings.

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“…This makes it relevant to study the different and interconnected mechanisms underlying spinal edema. However, the contusion model requires laminectomy to access to the spinal tissue unlike other models used to study ISP in closed canals [ 87 , 88 ]. This inherent step of the surgery by itself alleviates the impact of edema and the subsequent pressure increase, as reported in clinical findings [ 89 , 90 , 91 ].…”

Section: Edema Formation After Sci: a Loop Of Interconnected Mechanismsmentioning

confidence: 99%

Edema after CNS Trauma: A Focus on Spinal Cord Injury

Seblani

Decherchi

Brezun

2023

IJMS

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Edema after spinal cord injury (SCI) is one of the first observations after the primary injury and lasts for few days after trauma. It has serious consequences on the affected tissue and can aggravate the initial devastating condition. To date, the mechanisms of the water content increase after SCI are not fully understood. Edema formation results in a combination of interdependent factors related to mechanical damage after the initial trauma progressing, along with the subacute and acute phases of the secondary lesion. These factors include mechanical disruption and subsequent inflammatory permeabilization of the blood spinal cord barrier, increase in the capillary permeability, deregulation in the hydrostatic pressure, electrolyte-imbalanced membranes and water uptake in the cells. Previous research has attempted to characterize edema formation by focusing mainly on brain swelling. The purpose of this review is to summarize the current understanding of the differences in edema formation in the spinal cord and brain, and to highlight the importance of elucidating the specific mechanisms of edema formation after SCI. Additionally, it outlines findings on the spatiotemporal evolution of edema after spinal cord lesion and provides a general overview of prospective treatment strategies by focusing on insights to prevent edema formation after SCI.

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Elevated intraspinal pressure in traumatic spinal cord injury is a promising therapeutic target

Cited by 14 publications

References 109 publications

Outcomes of Patients with Cervical Spinal Cord Injury Treated by Surgery and Their Prognostic Factors

Outcomes of Patients with Cervical Spinal Cord Injury Treated by Surgery and Their Prognostic Factors

Early expansive single sided laminoplasty decompression treatment severe traumatic cervical spinal cord injury

Edema after CNS Trauma: A Focus on Spinal Cord Injury

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