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
Autor: | Isaac Phang, Georgios V. Varsos, Marios C. Papadopoulos, Marek Czosnyka, Argyro Zoumprouli, Samira Saadoun, Melissa C. Werndle |
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Rok vydání: | 2015 |
Předmět: |
duroplasty
Adult Male decompression medicine.medical_specialty Cord medicine.medical_treatment Blood Pressure perfusion pressure Lumbar Cerebrospinal Fluid Pressure medicine Humans Prospective Studies Spinal cord injury Spinal Cord Injuries business.industry Laminectomy Original Articles Middle Aged Decompression Surgical medicine.disease Spinal cord spinal cord injury Surgery Pseudomeningocele Treatment Outcome medicine.anatomical_structure Spinal decompression Anesthesia Female Neurology (clinical) Cerebrospinal fluid pressure business |
Zdroj: | Journal of Neurotrauma |
ISSN: | 1557-9042 0897-7151 |
Popis: | 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. |
Databáze: | OpenAIRE |
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