title: Cerebrospinal fluid drainage and induced hypertension improve spinal cord perfusion after acute spinal cord injury in pigs.
abstract: BACKGROUND
  Acute spinal cord injury (SCI) is commonly treated by elevating the mean arterial pressure (MAP). Other potential interventions include cerebrospinal fluid drainage (CSFD).
  
  
  OBJECTIVE
  To determine the efficacy of aggressive MAP elevation combined with intrathecal pressure (ITP) reduction; our primary objective was to improve spinal cord blood flow (SCBF) after SCI.
  
  
  METHODS
  All 15 pigs underwent laminectomy. Study groups included control (n = 3); SCI only (n = 3); SCI combined with MAP elevation (SCI + MAP) (n = 3); SCI combined with CSFD (SCI + CSFD) (n = 3); and SCI combined with both MAP elevation and CSFD (SCI + MAP + CSFD) (n = 3). SCBF was measured with laser Doppler flowmetry.
  
  
  RESULTS
  In the SCI group, SCBF decreased by 56% after SCI. MAP elevation after SCI resulted in a 34% decrease in SCBF, whereas CSFD resulted in a 59% decrease in SCBF. The combination of CSFD and MAP elevation resulted in a 24% increase in SCBF. The SCI + MAP group had an average ITP increase of 5.45 mm Hg after MAP elevation 1 hour after SCI and remained at that level throughout the experiment.
  
  
  CONCLUSIONS
  Both MAP elevation alone and CSFD alone led to only short-term improvement of SCBF. The combination of MAP elevation and CSFD significantly and sustainably improved SCBF and spinal cord perfusion pressure. Although laser Doppler flowmetry can provide flow measurements to a tissue depth of only 1.5 mm, these results may represent pattern of blood flow changes in the entire spinal cord after injury.
authors.affiliation: *Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; ‡Division of Neurosurgery, University of Arizona, Tucson, Arizona; §Division of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Nikolay L
authors.initials: NL
authors.lastname: Martirosyan
authors.forename: M Yashar S
authors.initials: MY
authors.lastname: Kalani
authors.forename: William D
authors.initials: WD
authors.lastname: Bichard
authors.forename: Ali A
authors.initials: AA
authors.lastname: Baaj
authors.forename: L Fernando
authors.initials: LF
authors.lastname: Gonzalez
authors.forename: Mark C
authors.initials: MC
authors.lastname: Preul
authors.forename: Nicholas
authors.initials: N
authors.lastname: Theodore
mesh_terms: D000818:Animals; D002555:Cerebrospinal Fluid; D004195:Disease Models, Animal; D006439:Hemodynamics / Q000502:physiology*; D006973:Hypertension; D017078:Laser-Doppler Flowmetry; D008297:Male; D013116:Spinal Cord / Q000098:blood supply*; D013119:Spinal Cord Injuries / Q000134:cerebrospinal fluid* / Q000503:physiopathology*; D034421:Sus scrofa; D013552:Swine