103 Cerebrospinal Fluid Drainage in Acute Spinal Cord Injury: A Multi-Center, Randomized, Controlled Trial. (April 2023)

• Record Type: Journal Article
• Authors: Theodore, Nicholas; Martirosyan, Nikolay L.; Hersh, Andrew; Ehresman, Jeff; Ahmed, Ali Karim; Danielson, Jill; Sullivan, Cindy; Shank, Christopher D.; Almefty, Kaith K.; Lemole, G. Michael; Kakarla, Udaya K.; Hadley, Mark N.
• Is Part Of: Neurosurgery. Volume 69(2023)Supplement 1
• Page Start: 23
• Page End: 23
• Publication Date: 2023-04
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1227/neu.0000000000002375_103
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract : INTRODUCTION: The devastating sequelae of spinal cord injury (SCI) are worsened by ischemia and inflammation that occur following the primary mechanical damage to the cord. Optimizing spinal cord perfusion pressure (SCPP), calculated as the difference between mean arterial pressure (MAP) and intrathecal pressure (ITP), may improve long-term neurological outcomes. MAP augmentation is frequently used to improve perfusion; however, the efficacy of ITP reduction is less clear. METHODS: Patients with acute cervical SCI presenting within 24 hours were screened for eligibility. All patients received lumbar drain placement and appropriate decompressive surgery. Patients in the control group received MAP elevation only, while patients in the interventional group received MAP elevation and CSFD for a target ITP of below 10 mm Hg for 5 days. ITP and MAP were recorded hourly. Patients underwent functional assessments at enrollment, 72 hours, 90 days, and 180 days after injury. RESULTS: A total of 11 patients were enrolled, and four were randomized to receive CSFD. Patients in the CSFD cohort had a mean ITP of 5.3 ± 2.5 mm Hg compared to 15 ± 3.0 mm Hg in the control group. SCPP improved significantly from 77 ± 4.5 mm Hg in the control group to 101 ± 6.3 mm Hg in the experimental group (p < 0.01). Total motor scores improved by 15 ± 8.4 points and 57 ± 24 points in the control and CSFD groups, respectively, over 180 days. No adverse events were attributable to CSFD. CONCLUSIONS: CSFD is feasible and an effective mechanism for reducing ITP and improving SCPP in the acute period after SCI. The complication profile was similar between both groups, and long-term improvements in motor and sensory function were seen with CSFD.