title: 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.
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.
authors.affiliation: 1 Academic Neurosurgery Unit, St. George's University of London , United Kingdom .
authors.forename: Isaac
authors.initials: I
authors.lastname: Phang
authors.affiliation: 1 Academic Neurosurgery Unit, St. George's University of London , United Kingdom .
authors.forename: Melissa C
authors.initials: MC
authors.lastname: Werndle
authors.affiliation: 1 Academic Neurosurgery Unit, St. George's University of London , United Kingdom .
authors.forename: Samira
authors.initials: S
authors.lastname: Saadoun
authors.affiliation: 2 Department of Clinical Neurosciences, University of Cambridge , Cambridge, United Kingdom .
authors.forename: Georgios
authors.initials: G
authors.lastname: Varsos
authors.affiliation: 2 Department of Clinical Neurosciences, University of Cambridge , Cambridge, United Kingdom .
authors.forename: Marek
authors.initials: M
authors.lastname: Czosnyka
authors.affiliation: 3 Department of Anaesthesia, St. George's Hospital , London, United Kingdom .
authors.forename: Argyro
authors.initials: A
authors.lastname: Zoumprouli
authors.affiliation: 1 Academic Neurosurgery Unit, St. George's University of London , United Kingdom .
authors.forename: Marios C
authors.initials: MC
authors.lastname: Papadopoulos
mesh_terms: D000328:Adult; D001794:Blood Pressure / Q000502:physiology*; D015170:Cerebrospinal Fluid Pressure / Q000502:physiology*; D019299:Decompression, Surgical / Q000379:methods; D005260:Female; D006801:Humans; D007796:Laminectomy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013119:Spinal Cord Injuries / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D016896:Treatment Outcome
keywords: decompression; duroplasty; perfusion pressure; spinal cord injury