Measurement of Intraspinal Pressure After Spinal Cord Injury: Technical Note from the Injured Spinal Cord Pressure Evaluation Study

Werndle, Melissa C.; Saadoun, Samira; Phang, Isaac; Czosnyka, Marek; Varsos, Georgios V.; Czosnyka, Zofia; Smielewski, Peter; Jamous, Ali; Bell, B. Anthony; Zoumprouli, Argyro; Papadopoulos, Marios C.

doi:10.1007/978-3-319-22533-3_64

Cited by 23 publications

(13 citation statements)

References 12 publications

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“…It is important to note that we monitor ISP from the subdural space, which is less invasive than intraparenchymal ISP. When the injured cord is swollen and compressed against the dura, subdural ISP equals intraparenchymal ISP at the injury site [ 13 , 17 , 26 ]. After a mild TSCI, the spinal cord may not be compressed against the dura; in this case, the relation between subdural versus intraparenchymal ISP is unknown.…”

Section: Introductionmentioning

confidence: 99%

Spinal cord injury: is monitoring from the injury site the future?

Saadoun

Papadopoulos

2016

Crit Care

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This paper challenges the current management of acute traumatic spinal cord injury based on our experience with monitoring from the injury site in the neurointensive care unit. We argue that the concept of bony decompression is inadequate. The concept of optimum spinal cord perfusion pressure, which differs between patients, is introduced. Such variability suggests individualized patient treatment. Failing to optimize spinal cord perfusion limits the entry of systemically administered drugs into the injured cord. We conclude that monitoring from the injury site helps optimize management and should be subjected to a trial to determine whether it improves outcome.

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Section: Introductionmentioning

confidence: 99%

Spinal cord injury: is monitoring from the injury site the future?

Saadoun

Papadopoulos

2016

Crit Care

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“…We also showed that simultaneous monitoring of SCPP and microdialysis could be used to enhance drug entry at the injury site. Based on our current findings and earlier studies [4][5][6][7][8][9]20,21 , a large-scale study of outcome from TSCI in patients who have monitoring vs. those who do not is warranted.…”

Section: Annals Of Neurologymentioning

confidence: 61%

Microdialysis to Optimize Cord Perfusion and Drug Delivery in Spinal Cord Injury

Phang

Zoumprouli

Papadopoulos

et al. 2016

Annals of Neurology

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OBJECTIVE:There is lack of monitoring from the injury site to guide management of patients with acute traumatic spinal cord injury. Here we describe a bedside microdialysis monitoring technique for optimizing spinal cord perfusion and drug delivery at the injury site.METHODS: 14 patients were recruited within 72 hours of severe spinal cord injury. We inserted intradurally at the injury site a pressure probe, to monitor continuously spinal cord perfusion pressure, and a microdialysis catheter, to monitor hourly glycerol, glutamate, glucose, lactate and pyruvate. The pressure probe and microdialysis catheter were placed on the surface of the injured cord. RESULTS:Microdialysis monitoring did not cause serious complications. Spinal cord perfusion pressure 90 -100 mmHg and tissue glucose >4.5 mM minimized metabolic derangement at the injury site. Increasing spinal cord perfusion pressure by ~10 mmHg, increased the entry of intravenously administered dexamethasone at the injury site three-fold. INTERPRETATION:This study determined the optimum spinal cord perfusion pressure and optimum tissue glucose concentration at the injury site. We also identified spinal cord perfusion pressure as a key determinant of drug entry into the injured spinal cord. Our findings challenge current guidelines, which recommend maintaining mean arterial pressure at 85 -90 mmHg for a week after spinal cord injury. We propose that future drug trials for spinal cord injury include pressure and microdialysis monitoring to optimize spinal cord perfusion and maximize drug delivery at the injury site.

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“…When the spinal cord is swollen and compressed against the dura, the subdural pressure (i.e., ISP) and intraparenchymal pressure at the injury site are the same. In this case, ISP is higher than cerebrospinal fluid (CSF) pressure above or below the injury site—details are given elsewhere [5, 6, 13–15]. …”

Section: Methodsmentioning

confidence: 99%

Predictors of Intraspinal Pressure and Optimal Cord Perfusion Pressure After Traumatic Spinal Cord Injury

et al. 2018

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Background/ObjectivesWe recently developed techniques to monitor intraspinal pressure (ISP) and spinal cord perfusion pressure (SCPP) from the injury site to compute the optimum SCPP (SCPPopt) in patients with acute traumatic spinal cord injury (TSCI). We hypothesized that ISP and SCPPopt can be predicted using clinical factors instead of ISP monitoring.MethodsSixty-four TSCI patients, grades A–C (American spinal injuries association Impairment Scale, AIS), were analyzed. For 24 h after surgery, we monitored ISP and SCPP and computed SCPPopt (SCPP that optimizes pressure reactivity). We studied how well 28 factors correlate with mean ISP or SCPPopt including 7 patient-related, 3 injury-related, 6 management-related, and 12 preoperative MRI-related factors.ResultsAll patients underwent surgery to restore normal spinal alignment within 72 h of injury. Fifty-one percentage had U-shaped sPRx versus SCPP curves, thus allowing SCPPopt to be computed. Thirteen percentage, all AIS grade A or B, had no U-shaped sPRx versus SCPP curves. Thirty-six percentage (22/64) had U-shaped sPRx versus SCPP curves, but the SCPP did not reach the minimum of the curve, and thus, an exact SCPPopt could not be calculated. In total 5/28 factors were associated with lower ISP: older age, excess alcohol consumption, nonconus medullaris injury, expansion duroplasty, and less intraoperative bleeding. In a multivariate logistic regression model, these 5 factors predicted ISP as normal or high with 73% accuracy. Only 2/28 factors correlated with lower SCPPopt: higher mean ISP and conus medullaris injury. In an ordinal multivariate logistic regression model, these 2 factors predicted SCPPopt as low, medium–low, medium–high, or high with only 42% accuracy. No MRI factors correlated with ISP or SCPPopt.ConclusionsElevated ISP can be predicted by clinical factors. Modifiable factors that may lower ISP are: reducing surgical bleeding and performing expansion duroplasty. No factors accurately predict SCPPopt; thus, invasive monitoring remains the only way to estimate SCPPopt.Electronic supplementary materialThe online version of this article (10.1007/s12028-018-0616-7) contains supplementary material, which is available to authorized users.

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Measurement of Intraspinal Pressure After Spinal Cord Injury: Technical Note from the Injured Spinal Cord Pressure Evaluation Study

Cited by 23 publications

References 12 publications

Spinal cord injury: is monitoring from the injury site the future?

Spinal cord injury: is monitoring from the injury site the future?

Microdialysis to Optimize Cord Perfusion and Drug Delivery in Spinal Cord Injury

Predictors of Intraspinal Pressure and Optimal Cord Perfusion Pressure After Traumatic Spinal Cord Injury

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