Intraspinal pressure monitoring and extensive duroplasty in the acute phase of traumatic spinal cord injury. A systematic review.

Intraspinal pressure monitoring and extensive duroplasty in the acute phase of traumatic spinal cord injury. A systematic review.

World Neurosurg. 2017 May 31;:

Authors: Tomasz T, Poniatowski L, Czyz M, Koziara M, Wynne-Jones G

Abstract
The prognosis in cervical spinal cord injury (SCI) is poor and surgical and neuro intensive care management need further improvement. Monitoring of the intraspinal pressure (ISP) at early stage after tSCI is clinically useful. Obtaining continuous spinal cord perfusion pressure (SCPP) measurements based on the difference between mean arterial pressure (MAP) and ISP allows offering best medical and surgical treatment during this critical phase of tSCI. The optimal SCPP was found to be between 90-100mmHg and MAP of 110-130. Laminectomy alone was found to be ineffective in the reduction of ISP because it does not lower the pressure exerted by dura on the swollen spinal cord. Therefore, bony decompression with durotomy or duroplasty seems to be a procedure of choice to reduce the ISP below 20 mmHg. A randomized controlled trial is required to determine whether the laminectomy with durotomy and monitoring of ISP with SCPP optimization improve neurological recovery after tSCI.

PMID: 28578120 [PubMed - as supplied by publisher]

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