Intraspinal pressure and spinal cord perfusion pressure predict neurological outcome after traumatic spinal cord injury

Saadoun, Samira; Chen, Suliang; Papadopoulos, Marios C.

doi:10.1136/jnnp-2016-314600

Cited by 73 publications

(74 citation statements)

References 4 publications

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“…The chance of AIS grade conversion at 9-12 months after the TSCI negatively correlates with the mean ISP on admission and positively correlates with the mean SCPP on admission (Fig. 3) [43]. Increasing SCPP presumably reduces ischemia at the injury site.…”

Section: Therapies Based On Isp Monitoringmentioning

confidence: 96%

Targeted Perfusion Therapy in Spinal Cord Trauma

Saadoun

Papadopoulos

2020

Neurotherapeutics

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We review state-of-the-art monitoring techniques for acute, severe traumatic spinal cord injury (TSCI) to facilitate targeted perfusion of the injured cord rather than applying universal mean arterial pressure targets. Key concepts are discussed such as intraspinal pressure and spinal cord perfusion pressure (SCPP) at the injury site, respectively, analogous to intracranial pressure and cerebral perfusion pressure for traumatic brain injury. The concept of spinal cord autoregulation is introduced and quantified using spinal pressure reactivity index (sPRx), which is analogous to pressure reactivity index for traumatic brain injury. The Ushaped relationship between sPRx and SCPP defines the optimum SCPP as the SCPP that minimizes sPRx (i.e., maximizes autoregulation), and suggests that not only ischemia but also hyperemia at the injury site may be detrimental. The observation that optimum SCPP varies between patients and temporally in each patient supports individualized management. We discuss multimodality monitoring, which revealed strong correlations between SCPP and injury site metabolism (tissue glucose, lactate, pyruvate, glutamate, glycerol), monitored by surface microdialysis. Evidence is presented that the dura is a major, but unappreciated, cause of spinal cord compression after TSCI; we thus propose expansion duroplasty as a novel treatment. Monitoring spinal cord blood flow at the injury site has revealed novel phenomena, e.g., 3 distinct blood flow patterns, local steal, and diastolic ischemia. We conclude that monitoring from the injured spinal cord in the intensive care unit is a safe technique that appears to enable optimized and individualized spinal cord perfusion.

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Section: Therapies Based On Isp Monitoringmentioning

confidence: 96%

Targeted Perfusion Therapy in Spinal Cord Trauma

Saadoun

Papadopoulos

2020

Neurotherapeutics

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“…It was of belief that bony decompression with laminectomy released the spinal epidural veins which had become congested and had inhibited the free flow of CSF, and dural decompression can be used in the prevention of high ISP [17]. Papadopoulos also demonstrated that high ISP and low SCPP are associated with injury site ischaemia, which likely causes secondary damage [18]. In patients with extensive swelling from spinal cord injury, durotomy can relieve the blockage of spinal epidural veins and arterioles of the cord, as well as relieve secondary injury [19].…”

Section: Discussionmentioning

confidence: 99%

Method of Decompression by durotomy and duroplasty for cervical spinal cord injury in patients without fracture or dislocation

Telemacque

Zhu

Chen

et al. 2018

Journal of Neurorestoratology

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KEYWORDSspinal cord injury; spinal cord compartment syndrome; decompression; durotomy; spinal cord intramedullary hypertension. Introduction:We developed the method of cervical spinal cord decompression through durotomy followed by duroplasty and analyzed its efficacy. Purpose:To develop a tactic of decompression durotomy and duroplasty for the treatment of severe spinal cord injury(SCI) with extensive edema of the spinal cord and without intramedullary hematoma, and to demonstrate the effectiveness of this method. operations were performed in the cervical spine in patients with SCI. Decompression laminectomy was done without durotomy in the first group of patients. In the second group, duroplasty of the spinal cord was performed after decompression durotomy. A total of 17 patients, 16 males (94%) and 1 female (6%), were operated on (ages from 32 to 66 years). The patients were divided into two groups: a control group and an experimental group. We used the ASIA scale for assessing the patients. The mean follow up time is 12 months (8−24 months). Results:The first group, i.e., the control group consisted of 10 patients who underwent decompression laminectomy without durotomy. The second group, i.e., the experimental group consisted of 7 patients who underwent durotomy followed by duroplasty. In this group, the positive dynamics were observed in 6 patients. Out of 2 patients with ASIA grade "A", one showed improvement to ASIA grade "C", and one improved to ASIA "D". Two patients with ASIA grade "B" showed recovery to ASIA "D". Two patients with ASIA grade "C" improved to grade "D" while one patient showed no change from ASIA "C". Durotomy and duroplasty was effective in the experimental group. Conclusion:The performance of durotomy and duroplasty is an efficient method for the full-scale decompression of the spinal cord and the prevention of edema. This method aims at decreasing intraspinal pressure, as well as preventing ischemia and apoptosis, which is possible for the prevention and treatment of the spinal cord compartment syndrome or spinal cord intramedullary hypertension.

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“…Time series are also used to identify correlations with biological meaning e.g. higher ISP correlates with worse neurological outcome 13 , when ISP increases then sPRx increases (impaired autoregulation) 1,8 and tissue lactate to pyruvate ratio also increases (increased tissue ischemia) 12 Unlike ISP monitoring for TSCI, ICP monitoring for severe TBI has been the standard of care in developed countries for many years 21,22 . The early management of patients with TBI is focused on limiting secondary injury by reducing ICP below 25 mmHg and increasing CPP above 60 mmHg.…”

Section: Discussionmentioning

confidence: 99%

“…Second, intervention to increase SCPP in TSCI patients improves neurological status in some patients 1 . Third, lower mean ISP and higher mean SCPP correlate with improved long-term neurological outcome 13 . Fourth, intervening to increase SCPP increases the amplitude of motor evoked responses monitored from below the injury site in some patients 1 .…”

Section: Introductionmentioning

confidence: 92%

Visibility Graph Analysis of Intraspinal Pressure Signal Predicts Functional Outcome in Spinal Cord Injured Patients

Chen

Gallagher

Hogg

et al. 2018

Journal of Neurotrauma

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To guide management of patients with acute spinal cord injuries, we developed intraspinal pressure monitoring from the injury site. Here, we examine the complex fluctuations in the intraspinal pressure signal using network theory. We analyzed 7097 h of intraspinal pressure data from 58 patients with severe cord injuries. Intraspinal pressure signals were split into hourly windows. Each window was mapped into a visibility graph as follows. Vertical bars were drawn at 0.1 Hz representing signal amplitudes. Each bar produced a node, thus totalling 360 nodes per graph. Two nodes were linked with an edge if the straight line through the nodes did not intersect a bar. We computed several topological metrics for each graph including diameter, modularity, eccentricity, and small-worldness. Patients were followed up for 20 months on average. Our data show that the topological structure of intraspinal pressure visibility graphs is highly sensitive to pathological events at the injury site, including cord compression (high intraspinal pressure), ischemia (low spinal cord perfusion pressure), and deranged autoregulation (high spinal pressure reactivity index). These pathological changes correlate with long graph diameter, high modularity, high eccentricity and reduced small-worldness. In a multivariate logistic regression model, age, neurological status on admission, and average node eccentricity were independent predictors of neurological improvement. We conclude that analysis of intraspinal pressure fluctuations after spinal cord injury as graphs, rather than as time series, captures clinically important information. Our novel technique may be applied to other signals recorded from injured central nervous system (CNS); for example, intracranial pressure, tissue metabolite, and oxygen levels.

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Intraspinal pressure and spinal cord perfusion pressure predict neurological outcome after traumatic spinal cord injury

Cited by 73 publications

References 4 publications

Targeted Perfusion Therapy in Spinal Cord Trauma

Targeted Perfusion Therapy in Spinal Cord Trauma

Method of Decompression by durotomy and duroplasty for cervical spinal cord injury in patients without fracture or dislocation

Visibility Graph Analysis of Intraspinal Pressure Signal Predicts Functional Outcome in Spinal Cord Injured Patients

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