SORA

Advancing, promoting and sharing knowledge of health through excellence in teaching, clinical practice and research into the prevention and treatment of illness

Expansion duroplasty improves intraspinal pressure, spinal cord perfusion pressure, and vascular pressure reactivity index in patients with traumatic spinal cord injury: injured spinal cord pressure evaluation study.

Phang, I; Werndle, MC; Saadoun, S; Varsos, G; Czosnyka, M; Zoumprouli, A; Papadopoulos, MC (2015) Expansion duroplasty improves intraspinal pressure, spinal cord perfusion pressure, and vascular pressure reactivity index in patients with traumatic spinal cord injury: injured spinal cord pressure evaluation study. Journal of Neurotrauma, 32 (12). pp. 865-874. https://doi.org/10.1089/neu.2014.3668
SGUL Authors: Papadopoulos, Marios Phang, Isaac Sng Khai

[img]
Preview
PDF Published Version
Available under License Creative Commons Attribution Non-commercial.

Download (803kB) | Preview

Abstract

We recently showed that, after traumatic spinal cord injury (TSCI), laminectomy does not improve intraspinal pressure (ISP), spinal cord perfusion pressure (SCPP), or the vascular pressure reactivity index (sPRx) at the injury site sufficiently because of dural compression. This is an open label, prospective trial comparing combined bony and dural decompression versus laminectomy. Twenty-one patients with acute severe TSCI had re-alignment of the fracture and surgical fixation; 11 had laminectomy alone (laminectomy group) and 10 had laminectomy and duroplasty (laminectomy+duroplasty group). Primary outcomes were magnetic resonance imaging evidence of spinal cord decompression (increase in intradural space, cerebrospinal fluid around the injured cord) and spinal cord physiology (ISP, SCPP, sPRx). The laminectomy and laminectomy+duroplasty groups were well matched. Compared with the laminectomy group, the laminectomy+duroplasty group had greater increase in intradural space at the injury site and more effective decompression of the injured cord. In the laminectomy+duroplasty group, ISP was lower, SCPP higher, and sPRx lower, (i.e., improved vascular pressure reactivity), compared with the laminectomy group. Laminectomy+duroplasty caused cerebrospinal fluid leak that settled with lumbar drain in one patient and pseudomeningocele that resolved completely in five patients. We conclude that, after TSCI, laminectomy+duroplasty improves spinal cord radiological and physiological parameters more effectively than laminectomy alone.

Item Type: Article
Additional Information: © Isaac Phang, Melissa C. Werndle, Samira Saadoun, Georgios Varsos, Marek Czosnyka, Argyro Zoumprouli, Marios C. Papadopoulos 2015; Published by Mary Ann Liebert, Inc. This Open Access article is distributed under the terms of the Creative Commons Attribution Noncommercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.
Keywords: decompression, duroplasty, perfusion pressure, spinal cord injury, decompression, duroplasty, perfusion pressure, spinal cord injury, Neurology & Neurosurgery, 1103 Clinical Sciences, 1109 Neurosciences
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Academic Structure > Molecular and Clinical Sciences Research Institute (MCS) > Neuroscience (INCCNS)
Journal or Publication Title: Journal of Neurotrauma
Language: eng
Dates:
DateEvent
4 May 2015Published
Publisher License: Creative Commons: Attribution-Noncommercial 4.0
PubMed ID: 25705999
Web of Science ID: WOS:000363948800001
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/107690
Publisher's version: https://doi.org/10.1089/neu.2014.3668

Actions (login required)

Edit Item Edit Item