title: Increased intrathecal pressure after traumatic spinal cord injury: an illustrative case presentation and a review of the literature.
abstract: Early surgical management after traumatic spinal cord injury (SCI) is nowadays recommended. Since posttraumatic ischemia is an important sequel after SCI, maintenance of an adequate mean arterial pressure (MAP) within the first week remains crucial in order to warrant sufficient spinal cord perfusion. However, the contribution of raised intraparenchymal and consecutively increased intrathecal pressure has not been implemented in treatment strategies.
  
  
  
  Case report and review of the literature.
  
  
  
  Here we report a case of a 54-year old man who experienced a thoracic spinal cord injury after a fall. CT-examination revealed complex fractures of the thoracic spine. The patient underwent prompt surgical intervention. Intraoperatively, fractured parts of the ascending Th5 facet joint were displaced into the spinal cord itself. Upon removal, excessive protruding of medullary tissue was observed over several minutes. This demonstrates the clinical relevance of increased intrathecal pressure in some patients.
  
  
  
  Monitoring and counteracting raised intrathecal pressure should guide clinical decision-making in the future in order to ensure optimal spinal cord perfusion pressure for every affected individual.
authors.affiliation: Center for Spinal Cord Injuries, Trauma Center Murnau, Murnau, Germany. lukas.grassner@googlemail.com.|Department of Neurosurgery, Trauma Center Murnau, Murnau, Germany. lukas.grassner@googlemail.com.|Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria. lukas.grassner@googlemail.com.|Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria. lukas.grassner@googlemail.com.
authors.forename: Lukas
authors.identifier: 0000-0002-3390-0895
authors.initials: L
authors.lastname: Grassner
authors.affiliation: Department of Neurosurgery, Christian Doppler Clinic Salzburg, Paracelsus Medical University, Salzburg, Austria.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Winkler
authors.affiliation: Department of Neurosurgery, Trauma Center Murnau, Murnau, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Strowitzki
authors.affiliation: Center for Spinal Cord Injuries, Trauma Center Murnau, Murnau, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Bühren
authors.affiliation: Center for Spinal Cord Injuries, Trauma Center Murnau, Murnau, Germany.
authors.forename: Doris
authors.initials: D
authors.lastname: Maier
authors.affiliation: Department of Neurosurgery, Trauma Center Murnau, Murnau, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Bierschneider
mesh_terms: D000058:Accidental Falls; D015170:Cerebrospinal Fluid Pressure / Q000502:physiology*; D000072039:Fracture Dislocation / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013119:Spinal Cord Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries / Q000503:physiopathology*; D021801:Zygapophyseal Joint / Q000000981:diagnostic imaging / Q000293:injuries / Q000503:physiopathology*
keywords: Intraspinal pressure; Outcome; Spinal cord injury; Spine surgery