Proposal of a Management Algorithm to Predict the Need for Expansion Duraplasty in American Spinal Injury Association Impairment Scale Grades A–C Traumatic Cervical Spinal Cord Injury Patients

Autor: Bizhan, Aarabi, Chen, Chixiang, J Marc, Simard, Timothy, Chryssikos, Jesse A, Stokum, Charles A, Sansur, Kenneth M, Crandall, Joshua, Olexa, Jeffrey, Oliver, Melissa R, Meister, Gregory, Cannarsa, Ashish, Sharma, Cara, Lomangino, Maureen, Scarboro, Abdul-Kareem, Ahmed, Nathan, Han, Riccardo, Serra, Phelan, Shea, Carla, Aresco, Gary T, Schwartzbauer
Rok vydání: 2022
Předmět:
Zdroj: Journal of Neurotrauma. 39:1716-1726
ISSN: 1557-9042
0897-7151
DOI: 10.1089/neu.2022.0218
Popis: Expansion duraplasty to reopen effaced subarachnoid space and improve spinal cord perfusion, autoregulation, and spinal pressure reactivity index (sPRX) has been advocated in patients with traumatic cervical spinal cord injury (tCSCI). We designed this study to identify candidates for expansion duraplasty, based on the absence of cerebrospinal fluid (CSF) interface around the spinal cord on magnetic resonance imaging (MRI), in the setting of otherwise adequate bony decompression. Over a 61-month period, 104 consecutive American Spinal Injury Association Impairment Scale (AIS) grades A-C patients with tCSCI had post-operative MRI to assess the adequacy of surgical decompression. Their mean age was 53.4 years, and 89% were male. Sixty-one patients had falls, 31 motor vehicle collisions, 11 sport injuries, and one an assault. The AIS grade was A in 56, B in 18, and C in 30 patients. Fifty-four patients had fracture dislocations; there was no evidence of skeletal injury in 50 patients. Mean intramedullary lesion length (IMLL) was 46.9 (standard deviation = 19.4) mm. Median time from injury to decompression was 17 h (interquartile range 15.2 h). After surgery, 94 patients had adequate decompression as judged by the presence of CSF anterior and posterior to the spinal cord, whereas 10 patients had effacement of the subarachnoid space at the injury epicenter. In two patients whose decompression was not definitive and post-operative MRI indicated inadequate decompression, expansion duraplasty was performed. Candidates for expansion duraplasty (i.e., those with inadequate decompression) were significantly younger (
Databáze: OpenAIRE
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