Significance of spinal cord perfusion pressure following spinal cord injury: A systematic scoping review

Gee, Cameron M.

doi:10.1016/j.jcot.2022.102024

Cited by 7 publications

(9 citation statements)

References 95 publications

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“…In this case report, we saw trends towards higher values of ScPrx when intraspinal pressure and mean arterial pressure were elevated while lower ISP and MAP were correlated with ScPRx values in lower ranges. Despite the extensive physiologic data obtained from this technique, others have indicated concerns related to the possibility of cerebrospinal fluid leakage around the insertion of the wire and the possibility of exacerbating neurological injury through placement of the wire at the site of injury (24). Moreover, it remains unclear where the catheter should be positioned in relation to the site of injury.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the extensive physiologic data obtained from this technique, others have indicated concerns related to the possibility of cerebrospinal fluid leakage around the insertion of the wire and the possibility of exacerbating neurological injury through placement of the wire at the site of injury ( 24 ). Moreover, it remains unclear where the catheter should be positioned in relation to the site of injury.…”

Section: Discussionmentioning

confidence: 99%

“…24 am Patient presents to the tertiary care hospital for assessment after a fall off of scaffolding.9:53 amTrauma assessment is completed by the emergency room physician.9:57 am CT scan of the brain, chest, abdomen, pelvis and spine are completed. 10:20 am Spine surgery consultation.…”

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confidence: 99%

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Case report: Continuous spinal cord physiologic monitoring following traumatic spinal cord injury—A report from the Winnipeg Intraspinal Pressure Study (WISP)

2023

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IntroductionAcute traumatic spinal cord injury is routinely managed by surgical decompression and instrumentation of the spine. Guidelines also suggest elevating mean arterial pressure to 85 mmHg to mitigate secondary injury. However, the evidence for these recommendations remains very limited. There is now considerable interest in measuring spinal cord perfusion pressure by monitoring mean arterial pressure and intraspinal pressure. Here, we present our first institutional experience of using a strain gauge pressure transducer monitor to measure intraspinal pressure and subsequent derivation of spinal cord perfusion pressure.Case presentationThe patient presented to medical attention after a fall off of scaffolding. A trauma assessment was completed at a local emergency room. He did not have any motor strength or sensation to the lower extremities. A computed tomography (CT) scan of the thoracolumbar spine confirmed a T12 burst fracture with retropulsion of bone fragments into the spinal canal. He was taken to surgery for urgent decompression of the spinal cord and instrumentation of the spine. A subdural strain gauge pressure monitor was placed at the site of injury through a small dural incision. Mean arterial pressure and intraspinal pressure were then monitored for 5 days after surgery. Spinal cord perfusion pressure was derived. The procedure was performed without complication and the patient underwent rehabilitation for 3 months where he regained some motor and sensory function in his lower extremities.ConclusionThe first North American attempt at insertion of a strain gauge pressure monitor into the subdural space at the site of injury following acute traumatic spinal cord injury was performed successfully and without complication. Spinal cord perfusion pressure was derived successfully using this physiological monitoring. Further research efforts to validate this technique are required.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Case report: Continuous spinal cord physiologic monitoring following traumatic spinal cord injury—A report from the Winnipeg Intraspinal Pressure Study (WISP)

2023

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“…It is generally understood that hemodynamic management, along with cardiac and respiratory monitoring within the first few days after SCI may decrease the risk of secondary injury due to spinal cord ischemia ( Gee and Kwon, 2022 ). Moreover, it is though that drugs for the treatment of tSCI better reach their acting site with an increase of MAPs ( Saadoun and Papadopoulos, 2020 ).…”

Section: Clinical Managementmentioning

confidence: 99%

“…As hemodynamic monitoring requires invasive monitoring and potential intravenous administration of fluids and vasopressors, it may pose a challenge for early mobilization. This in turn may potentially increase the risk for complications associated with immobilization ( Saadoun and Papadopoulos, 2020 ; Gee and Kwon, 2022 ).…”

Section: Clinical Managementmentioning

confidence: 99%

Advancements in neuroregenerative and neuroprotective therapies for traumatic spinal cord injury

Fischer,

Bättig,

Stienen

et al. 2024

Front. Neurosci.

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Traumatic spinal cord injuries (SCIs) continue to be a major healthcare concern, with a rising prevalence worldwide. In response to this growing medical challenge, considerable scientific attention has been devoted to developing neuroprotective and neuroregenerative strategies aimed at improving the prognosis and quality of life for individuals with SCIs. This comprehensive review aims to provide an up-to-date and thorough overview of the latest neuroregenerative and neuroprotective therapies currently under investigation. These strategies encompass a multifaceted approach that include neuropharmacological interventions, cell-based therapies, and other promising strategies such as biomaterial scaffolds and neuro-modulation therapies. In addition, the review discusses the importance of acute clinical management, including the role of hemodynamic management as well as timing and technical aspects of surgery as key factors mitigating the secondary injury following SCI. In conclusion, this review underscores the ongoing scientific efforts to enhance patient outcomes and quality of life, focusing on upcoming strategies for the management of traumatic SCI. Each section provides a working knowledge of the fundamental preclinical and patient trials relevant to clinicians while underscoring the pathophysiologic rationale for the therapies.

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Early surgical intervention for acute spinal cord injury: time is spine

et al. 2023

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Significance of spinal cord perfusion pressure following spinal cord injury: A systematic scoping review

Cited by 7 publications

References 95 publications

Case report: Continuous spinal cord physiologic monitoring following traumatic spinal cord injury—A report from the Winnipeg Intraspinal Pressure Study (WISP)

Case report: Continuous spinal cord physiologic monitoring following traumatic spinal cord injury—A report from the Winnipeg Intraspinal Pressure Study (WISP)

Advancements in neuroregenerative and neuroprotective therapies for traumatic spinal cord injury

Early surgical intervention for acute spinal cord injury: time is spine

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