Experimental Treatments of Acute Spinal Cord Injury

Abstract

LTHOUGH physicians have a choice of treating acute injuries of the spinal cord by realignment of the spinal column, surgical decompression, or measures that alter neuronal metabolism and prevent or reduce edema of the cord, or by combinations of these methods, the relative merits of these procedures appear to be unknown because they have not been evaluated comparatively. There is no known experimental model to assess bony alignment, but Freeman and Wright s have described an experimental spinal cord concussion-contusion in which sufficient threshold trauma produces at least a moderately prolonged paraplegia and possibly a lasting neurological deficit and by which the relative efficacy of most current treatments could be compared. Using a similar experimental model, we evaluated standard dural decompression, direct local cord hypothermia, intramuscular dexamethasone, and intrathecal methylprednisolone. Materials and Methods We used beagle dogs:~ raised specifically for research; all were young and weighed 8.4 to 15 kg. Most of the animals weighed approximately 12 kg and were female. They were anesthetized with intravenous sodium pentobarbital (30 mg/kg). Endotracheal tubes were placed in all the dogs, but assisted respiration was not required. Following the usual aseptic technique, a midline longitudinal incision was utilized to remove the posterior laminae of the tenth, eleventh, and twelfth dorsal vertebrae completely. The epidural fat was removed, but the dura was not opened.

Treatment results of spinal cord injuries in the Swiss paraplegic centre of Basle

“…Apart from its classical anti-edema action it might, in the light of recent experimentation (Lewin et al, 1974;Eidelberg et al, 1975) have a role in preventing an increased potassium outflux from the injured spinal cord cells. The very early timing of this specific treatment is important, as demonstrated by Ducker and Hamit (1969), Lewin et al (1974) andCampbell et al (1974).…”

“…Table II gives a summary of the main causes of injuries: 39 per cent were traffic accidents of which roughly one-third were car drivers, one-third passengers and one-third motorcyclists. We can also see the high incidence of industrial In the last two years we have adopted a more medical attitude in the treat ment of spinal cord injury itself, based on the recent results of research in neuro physiopathology occurring immediately and within the first hours after trauma in animal experimentation (Peterson et ai., 1965;Ducker & Hamit, 1969;Hedeman & Sil, 1974;Lewin et ai., 1974;de la Torre et ai., 1974;Osterholm, 1974;Campbell et al, 1974;Eidelberg et at., 1975;Yeo et ai., 1975). The relation between haemorrhagic shock and its direct effect on the nervous system must also be considered in the early treatment of spinal cord injury (Peterson et al, 1965).…”

The prognosis of patients sustaining severe cervical spine injury (C2-C7 inclusive)

“…There has been a great resurgence in experimental animal studies in spinal cord injury, including the important work of Black and Markowitz (1971) ;Ducker and Hamit (1969); Hedeman and Sil (1974); Osterholm and Matthews (1971); Tator (1972) and Tator and Deecke (1973), and important new chemo-patho physiological information is being reported, along with studies on various forms of treatment. However, unfortunately, it would not appear that there are direct applications to spinal cord injury in man.…”

A review and update of experiment and clinical studies of spinal cord injury

“…Many studies have failed to consider these controls and entered variables that make interpretations of the result difficult or impossible. A major technique in studying possible causes of secondary injury is to determine the effect of various treatment regimes on expected neurological dysfunction following an injury (Ducker and Hamit, 1969;Campbell et at., 1973;de la Torre, 1981). It is thus important that experimental spinal cord injury outcome be predictably consistent.…”