title: Spinal cord injury: is monitoring from the injury site the future?
abstract: This paper challenges the current management of acute traumatic spinal cord injury based on our experience with monitoring from the injury site in the neurointensive care unit. We argue that the concept of bony decompression is inadequate. The concept of optimum spinal cord perfusion pressure, which differs between patients, is introduced. Such variability suggests individualized patient treatment. Failing to optimize spinal cord perfusion limits the entry of systemically administered drugs into the injured cord. We conclude that monitoring from the injury site helps optimize management and should be subjected to a trial to determine whether it improves outcome.
authors.affiliation: Academic Neurosurgery Unit, St. George's, University of London, Cranmer Terrace, Tooting, London, SW17 0RE, UK.
authors.forename: Samira
authors.initials: S
authors.lastname: Saadoun
authors.affiliation: Academic Neurosurgery Unit, St. George's, University of London, Cranmer Terrace, Tooting, London, SW17 0RE, UK. mpapadop@sgul.ac.uk.
authors.forename: Marios C
authors.identifier: http://orcid.org/0000-0001-9174-4176
authors.initials: MC
authors.lastname: Papadopoulos
mesh_terms: D000818:Animals; D062186:Arterial Pressure / Q000502:physiology*; D001794:Blood Pressure / Q000502:physiology; D004388:Dura Mater / Q000503:physiopathology; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration / Q000592:standards; D008279:Magnetic Resonance Imaging; D008775:Methylprednisolone / Q000494:pharmacology / Q000627:therapeutic use; D051379:Mice; D008991:Monitoring, Physiologic / Q000379:methods; D018802:Patient-Centered Care / Q000379:methods; D010477:Perfusion / Q000379:methods*; D013119:Spinal Cord Injuries / Q000601:surgery / Q000628:therapy*; D013256:Steroids / Q000494:pharmacology / Q000627:therapeutic use; D013552:Swine; D014947:Wounds and Injuries / Q000628:therapy
chemical_list: D013256:Steroids; D008775:Methylprednisolone
keywords: Blood pressure; CNS injury; Clinical trial; Microdialysis; Monitoring; Neurocritical care; Spinal cord injury; Surgery