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Coleman-Bock J, Bäcker HC, Johnson MA, Turner P, Cunningham J. Subacute Posttraumatic Ascending Myelopathy: Case Report and Systematic Review of the Literature. Clin Spine Surg 2023; 36:157-162. [PMID: 36253913 DOI: 10.1097/bsd.0000000000001394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 08/17/2022] [Indexed: 11/27/2022]
Abstract
STUDY DESIGN Case report and literature review. OBJECTION Aim of this study was to summarize the current evidence base behind subacute posttraumatic ascending myelopathy (SPAM) including the epidemiology, presentation, diagnosis, prognosis, and etiology. SUMMARY OF BACKGROUND DATA SPAM is a rare, potentially fatal disorder which is not attributable to ongoing mechanical instability, syrinx formation, or iatrogenic causes. METHODS A systematic literature search on SPAM was performed on Medline, Ovid, Cochrane, Embase, and PubMed databases between 1969 and 2021. Cases were reviewed and the findings summarized. Further evidence was reviewed to support the hypothesis that disruption of cerebrospinal fluid (CSF) circulation is the underlying etiology of the condition. RESULTS It is estimated to occur in 0.4%-0.7% of spinal cord injuries and may have a mortality of up to 10%. The most likely etiology disruption of CSF circulation leading to further damage to the spinal cord presumably through pressure mediated effects such as a reduction in cellular perfusion. CONCLUSION There is effectively no treatment of this condition, however, with interest developing in monitoring of CSF pressures during spinal cord injury this may help confirm the etiology, and allow the suggestion of therapies such as drains or expansion duraplasty to reduce spinal cord pressures. LEVEL OF EVIDENCE Level II-case report and systematic review.
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Basu S, Gohil K. Subacute Posttraumatic Ascending Myelopathy After Thoracolumbar Spinal Cord Injury. JBJS Rev 2022; 10:01874474-202210000-00004. [PMID: 36206362 DOI: 10.2106/jbjs.rvw.22.00097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
➢ Subacute posttraumatic ascending myelopathy (SPAM) is defined as neurological deterioration ascending four or more levels above the initial injury level and occurring within the initial days to weeks after spinal cord injury (SCI). ➢ SPAM is a rare complication of spinal cord injury with an incidence of 0.42% to 1% affecting young to middle-aged male patients. ➢ Several hypotheses have been put forth to explain SPAM, but the exact pathomechanism remains elusive. ➢ Treatment guidelines for this rare entity are uncertain and still to be developed. ➢ The current prognosis of SPAM is poor, with a mortality rate of 10.34%.
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Affiliation(s)
- Saumyajit Basu
- Department of Spine Surgery, Kothari Medical Centre, Kolkata, India
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Yang C, He T, Wang Q, Wang G, Ma J, Chen Z, Li Q, Wang L, Quan Z. Elevated intraspinal pressure drives edema progression after acute compression spinal cord injury in rabbits. Exp Neurol 2022; 357:114206. [PMID: 35988698 DOI: 10.1016/j.expneurol.2022.114206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/22/2022] [Accepted: 08/12/2022] [Indexed: 11/04/2022]
Abstract
Elevated intraspinal pressure (ISP) following traumatic spinal cord injury (tSCI) can be an important factor for secondary SCI that may result in greater tissue damage and functional deficits. Our present study aimed to investigate the dynamic changes in ISP after different degrees of acute compression SCI in rabbits with closed canals and explore its influence on spinal cord pathophysiology. Closed balloon compression injuries were induced with different inflated volumes (40 μl, 50 μl or no inflation) at the T7/8 level in rabbits. ISP was monitored by a SOPHYSA probe at the epicenter within 7 days post-SCI. Edema progression, spinal cord perfusion and damage severity were evaluated by serial multisequence MRI scans, somatosensory evoked potentials (SEPs) and behavioral scores. Histological and blood spinal cord barrier (BSCB) permeability results were subsequently analyzed. The results showed that the ISP waveforms comprised three peaks, significantly increased after tSCI, peaked at 72 h (21.86 ± 3.13 mmHg) in the moderate group or 48 h (31.71 ± 6.02 mmHg) in the severe group and exhibited "slow elevated and fast decreased" or "fast elevated and slow decreased" dynamic changes in both injured groups. Elevated ISP after injury was correlated with spinal cord perfusion and edema progression, leading to secondary lesion enlargement. The secondary damage aggravation can be visualized by diffusion tensor tractography (DTT). Moreover, the BSCB permeability was significantly increased at the epicenter and rostrocaudal segments at 72 h after SCI; by 14 days, notable permeability was still observed at the caudal segment in the severely injured rabbits. Our results suggest that the ISP of rabbits with closed canals increased after acute compression SCI and exhibited different dynamic change patterns in moderately and severely injured rabbits. Elevated ISP exacerbated spinal cord perfusion, drove edema progression and led to secondary lesion enlargement that was strongly associated with BSCB disruption. For severe tSCI, early intervention targeting elevated ISP may be an indispensable choice to rescue spinal cord function.
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Affiliation(s)
- Chaohua Yang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing 400016, China; Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, No.25 Taiping Street, Jiangyang District, Sichuan 646000, China; Orthopedic Laboratory of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing 400016, China.
| | - Tao He
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing 400016, China; Orthopedic Laboratory of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing 400016, China; Department of Orthopaedic Trauma, Chongqing General Hospital, No.118 Xingguang Avenue, Liangjiang New District, Chongqing 40114, China
| | - Qing Wang
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, No.25 Taiping Street, Jiangyang District, Sichuan 646000, China
| | - Gaoju Wang
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, No.25 Taiping Street, Jiangyang District, Sichuan 646000, China
| | - Jingjin Ma
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing 400016, China; Orthopedic Laboratory of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Zhiyu Chen
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing 400016, China; Orthopedic Laboratory of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Qiaochu Li
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing 400016, China; Orthopedic Laboratory of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Linbang Wang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing 400016, China; Orthopedic Laboratory of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Zhengxue Quan
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing 400016, China; Orthopedic Laboratory of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing 400016, China.
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Basu S, Gohil K, Sarangi T. Subacute Posttraumatic Ascending Myelopathy: A Rare Complication After Thoracolumbar Spinal Cord Injury: A Case Report. JBJS Case Connect 2022; 12:01709767-202203000-00052. [PMID: 35171854 DOI: 10.2106/jbjs.cc.21.00822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 45-year-old man presented with posttraumatic fracture-dislocation of T11/12 with neurological level T8 AIS A. Sensory level progressed to T4 in the next day morning. He underwent T10, T11, T12, and L1 percutaneous pedicle screw-rod fixation. Postoperatively, there was rapid worsening of his neurology and within 48 hours, he became tetraplegic with neurological level C2 with respiratory paralysis requiring mechanical ventilation. He died on the 14th postoperative day. Clinicoradiological findings were consistent with subacute posttraumatic ascending myelopathy (SPAM). CONCLUSION Surgeons must be vigilant in days and weeks after spinal cord injury for early recognition and management of SPAM. Treatment guidelines are uncertain and yet to be developed.
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Affiliation(s)
- Saumyajit Basu
- Department of Spine Surgery, Kothari Medical Centre, Kolkata, India
| | - Kushal Gohil
- Department of Spine Surgery, Kothari Medical Centre, Kolkata, India
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Grassner L, Riemenschneider MJ, Altendorfer B, Grillhösl A, Arevalo-Martin A, Garcia-Ovejero D, Mach O, Maier D, Bierschneider M, Strowitzki M, Thomé C, Aigner L. Subarachnoid Fibrosis in Human Post-Traumatic Syringomyelia: A Prospective Observational Clinical Study. J Neuropathol Exp Neurol 2022; 81:149-153. [DOI: 10.1093/jnen/nlab121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lukas Grassner
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
- Center for Spinal Cord Injuries, Trauma Center Murnau, Murnau am Staffelsee, Germany
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria
- ParaMove, Paracelsus Medical University Salzburg and Center for Spinal Cord Injuries, Trauma Center Murnau, Murnau am Staffelsee, Germany
| | | | - Barbara Altendorfer
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Andreas Grillhösl
- Department of Neuroradiology, Trauma Center Murnau, Murnau am Staffelsee, Germany
| | - Angel Arevalo-Martin
- Laboratory of Neuroinflammation, Hospital Nacional de Paraplejicos (SESCAM), Toledo, Spain
| | - Daniel Garcia-Ovejero
- Laboratory of Neuroinflammation, Hospital Nacional de Paraplejicos (SESCAM), Toledo, Spain
| | - Orpheus Mach
- Center for Spinal Cord Injuries, Trauma Center Murnau, Murnau am Staffelsee, Germany
- ParaMove, Paracelsus Medical University Salzburg and Center for Spinal Cord Injuries, Trauma Center Murnau, Murnau am Staffelsee, Germany
| | - Doris Maier
- Center for Spinal Cord Injuries, Trauma Center Murnau, Murnau am Staffelsee, Germany
- ParaMove, Paracelsus Medical University Salzburg and Center for Spinal Cord Injuries, Trauma Center Murnau, Murnau am Staffelsee, Germany
| | | | - Martin Strowitzki
- Department of Neurosurgery, Trauma Center Murnau, Murnau am Staffelsee, Germany
| | - Claudius Thomé
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - Ludwig Aigner
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria
- ParaMove, Paracelsus Medical University Salzburg and Center for Spinal Cord Injuries, Trauma Center Murnau, Murnau am Staffelsee, Germany
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Yang CH, Quan ZX, Wang GJ, He T, Chen ZY, Li QC, Yang J, Wang Q. Elevated intraspinal pressure in traumatic spinal cord injury is a promising therapeutic target. Neural Regen Res 2022; 17:1703-1710. [PMID: 35017417 PMCID: PMC8820714 DOI: 10.4103/1673-5374.332203] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The currently recommended management for acute traumatic spinal cord injury aims to reduce the incidence of secondary injury and promote functional recovery. Elevated intraspinal pressure (ISP) likely plays an important role in the processes involved in secondary spinal cord injury, and should not be overlooked. However, the factors and detailed time course contributing to elevated ISP and its impact on pathophysiology after traumatic spinal cord injury have not been reviewed in the literature. Here, we review the etiology and progression of elevated ISP, as well as potential therapeutic measures that target elevated ISP. Elevated ISP is a time-dependent process that is mainly caused by hemorrhage, edema, and blood-spinal cord barrier destruction and peaks at 3 days after traumatic spinal cord injury. Duraplasty and hypertonic saline may be promising treatments for reducing ISP within this time window. Other potential treatments such as decompression, spinal cord incision, hemostasis, and methylprednisolone treatment require further validation.
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Affiliation(s)
- Chao-Hua Yang
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province; Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zheng-Xue Quan
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Gao-Ju Wang
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Tao He
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhi-Yu Chen
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qiao-Chu Li
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jin Yang
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Qing Wang
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
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Levi V, Franzini A, Di Cristofori A, Bertani G, Pluderi M. Subacute posttraumatic ascending myelopathy (SPAM): A potential complication of subarachnoid shunt for syringomyelia? J Spinal Cord Med 2020; 43:714-718. [PMID: 30156977 PMCID: PMC7534218 DOI: 10.1080/10790268.2018.1512735] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Context: Treatment of primary spinal syringomyelia is still controversial. Among others, shunting syrinx fluid to the subarachnoid, peritoneal or pleural space has been utilized with varying success. Shunt obstruction, migration, and infection represent the most common complications of these procedures. Findings: The authors present the case of an 81-year-old woman who developed an unusual neurological deterioration resembling a subacute posttraumatic ascending myelopathy (SPAM) after the insertion of a syringosubarachnoid shunt for the treatment of slow-growing D10 syringomyelia. Conclusion/Clinical Relevance: To date, no cases of SPAM secondary to the insertion of a syringosubarachnoid shunt for the treatment of syringomyelia have been reported. The potential pathogenesis related to this phenomenon is discussed.
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Affiliation(s)
- Vincenzo Levi
- Department of Neurosurgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Andrea Franzini
- Department of Neurosurgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Andrea Di Cristofori
- Department of Neurosurgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Giulio Bertani
- Department of Neurosurgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Mauro Pluderi
- Department of Neurosurgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
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8
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Qatomah AY, Alhabter A, Alqahtani A, Albshabshi A, Alnaami I. Subacute progressive ascending myelopathy following motor vehicle accident. Chirurgia (Bucur) 2019. [DOI: 10.23736/s0394-9508.18.04813-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Aydoseli A, Özgen U, Akgül T, Orhan EK, Adıyaman AE, Can H, Karadağ C. Subacute Traumatic Ascending Myelopathy in a 28-Year-Old Man: A Rare Case. World Neurosurg 2019; 128:143-148. [PMID: 31042601 DOI: 10.1016/j.wneu.2019.04.168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/18/2019] [Accepted: 04/19/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Subacute posttraumatic ascending myelopathy (SPAM) involves the rise in high signal intensity on T2-weighted images ≥4 vertebral segments above the initial injured site, and it usually occurs within the first few weeks after the injury. The pathophysiologic mechanisms of traumatic spinal cord damage are not clearly understood; however, there are some pathophysiologic processes such as arterial thrombosis, venous thrombosis, congestive ischemia, inflammatory or autoimmune reaction, and infection in the form of meningitis or myelitis that could lead to SPAM. CASE DESCRIPTION We present a case of T7 fracture because of left shoulder gunshot injury and ascending myelopathy up to the C2 vertebra level, which occurred 1 week after the gunshot injury, without pretraumatic cervical injury or syringomyelia. Although control magnetic resonance imaging findings showed the second rise in the high signal intensity level of the spinal cord, T2-weighted signal intensity and cord edema decreased and the patient showed neurologic improvement. CONCLUSIONS This was the first case in the literature that showed rise 2 times in high signal intensity level in the spinal cord because of gunshot injury. Inflammatory reactions and secondary injury processes might have led to neurologic deterioration and ascending myelopathy in our case; therefore, the patient may have shown neurologic improvement after methylprednisolone therapy because of its anti-inflammatory and antiedema effects. There is no clear evidence whether neurologic improvement is associated with steroid therapy or it is because of the natural course of SPAM.
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Affiliation(s)
- Aydın Aydoseli
- Department of Neurosurgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Utku Özgen
- Department of Neurosurgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey.
| | - Turgut Akgül
- Department of Orthopaedics and Traumatology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Elif Kocasoy Orhan
- Department of Neurology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Ali Ekrem Adıyaman
- Department of Neurosurgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Halil Can
- Department of Neurosurgery, Medicine Hospital, Istanbul, Turkey; Department of Neurosurgery, Biruni University, Istanbul, Turkey
| | - Cihat Karadağ
- Department of Neurosurgery, University Hospital Dusseldorf, Dusseldorf, Germany
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Zhang J, Wang G. Response to comment on subacute post-traumatic ascending myelopathy: a literature review. Spinal Cord Ser Cases 2017; 3:17014. [PMID: 28503321 DOI: 10.1038/scsandc.2017.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Jian Zhang
- Department of Orthopedic Surgery, Baodi District, Tianjin, China
| | - Guangshun Wang
- Department of Thoracic Surgery, Baodi District, Tianjin, China
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Miller BA, Ahmad FU. Subacute posttraumatic ascending myelopathy: a literature review. Spinal Cord Ser Cases 2017; 3:17012. [PMID: 28503320 PMCID: PMC5406930 DOI: 10.1038/scsandc.2017.12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Brandon A Miller
- Department of Neuorsurgery, Washington University in St Louis, St Louis, MO, USA
| | - Faiz U Ahmad
- Department of Neurosurgery, Emory University, Atlanta, GA, USA
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Khaing ZZ, Cates LN, Fischedick AE, McClintic AM, Mourad PD, Hofstetter CP. Temporal and Spatial Evolution of Raised Intraspinal Pressure after Traumatic Spinal Cord Injury. J Neurotrauma 2017; 34:645-651. [DOI: 10.1089/neu.2016.4490] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Zin Z. Khaing
- Department of Neurological Surgery, The University of Washington, Seattle, Washington
| | - Lindsay N. Cates
- Department of Neurological Surgery, The University of Washington, Seattle, Washington
| | - Amanda E. Fischedick
- Department of Neurological Surgery, The University of Washington, Seattle, Washington
| | - Abbi M. McClintic
- Department of Neurological Surgery, The University of Washington, Seattle, Washington
| | - Pierre D. Mourad
- Department of Neurological Surgery, The University of Washington, Seattle, Washington
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13
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Spinal cord trauma: pathophysiology, classification of spinal cord injury syndromes, treatment principles and controversies. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.mporth.2016.07.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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