1
|
Zeller SL, Stein A, Frid I, Carpenter AB, Soldozy S, Rawanduzy C, Rosenberg J, Bauerschmidt A, Al-Mufti F, Mayer SA, Kinon MD, Wainwright JV. Critical Care of Spinal Cord Injury. Curr Neurol Neurosci Rep 2024; 24:355-363. [PMID: 39008022 DOI: 10.1007/s11910-024-01357-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2024] [Indexed: 07/16/2024]
Abstract
PURPOSE OF REVIEW Spinal cord injury (SCI) is a major cause of morbidity and mortality, posing a significant financial burden on patients and the healthcare system. While little can be done to reverse the primary mechanical insult, minimizing secondary injury due to ischemia and inflammation and avoiding complications that adversely affect neurologic outcome represent major goals of management. This article reviews important considerations in the acute critical care management of SCI to improve outcomes. RECENT FINDINGS Neuroprotective agents, such as riluzole, may allow for improved neurologic recovery but require further investigation at this time. Various forms of neuromodulation, such as transcranial magnetic stimulation, are currently under investigation. Early decompression and stabilization of SCI is recommended within 24 h of injury when indicated. Spinal cord perfusion may be optimized with a mean arterial pressure goal from a lower limit of 75-80 to an upper limit of 90-95 mmHg for 3-7 days after injury. The use of corticosteroids remains controversial; however, initiation of a 24-h infusion of methylprednisolone 5.4 mg/kg/hour within 8 h of injury has been found to improve motor scores. Attentive pulmonary and urologic care along with early mobilization can reduce in-hospital complications.
Collapse
Affiliation(s)
- Sabrina L Zeller
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
- Department of Neurosurgery, New York Medical College, Valhalla, NY, USA
| | - Alan Stein
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
- Department of Neurosurgery, New York Medical College, Valhalla, NY, USA
| | - Ilya Frid
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
- Department of Neurosurgery, New York Medical College, Valhalla, NY, USA
| | - Austin B Carpenter
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
- Department of Neurosurgery, New York Medical College, Valhalla, NY, USA
| | - Sauson Soldozy
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
- Department of Neurosurgery, New York Medical College, Valhalla, NY, USA
| | - Cameron Rawanduzy
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
- Department of Neurosurgery, New York Medical College, Valhalla, NY, USA
| | - Jon Rosenberg
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
- Department of Neurosurgery, New York Medical College, Valhalla, NY, USA
| | - Andrew Bauerschmidt
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
- Department of Neurosurgery, New York Medical College, Valhalla, NY, USA
| | - Fawaz Al-Mufti
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
- Department of Neurosurgery, New York Medical College, Valhalla, NY, USA
| | - Stephan A Mayer
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
- Department of Neurosurgery, New York Medical College, Valhalla, NY, USA
| | - Merritt D Kinon
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
- Department of Neurosurgery, New York Medical College, Valhalla, NY, USA
- Department of Orthopedic Surgery, New York Medical College, 100 Woods Road, Valhalla, NY, 10595, USA
| | - John V Wainwright
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA.
- Department of Neurosurgery, New York Medical College, Valhalla, NY, USA.
- Department of Orthopedic Surgery, New York Medical College, 100 Woods Road, Valhalla, NY, 10595, USA.
| |
Collapse
|
2
|
Jin C, Wang K, Ren Y, Li Y, Wang Z, Cheng L, Xie N. Role of durotomy on function outcome, tissue sparing, inflammation, and tissue stiffness after spinal cord injury in rats. MedComm (Beijing) 2024; 5:e530. [PMID: 38576458 PMCID: PMC10993870 DOI: 10.1002/mco2.530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 01/18/2024] [Accepted: 02/02/2024] [Indexed: 04/06/2024] Open
Abstract
Currently, there is a lack of effective treatments for spinal cord injury (SCI), a debilitating medical condition associated with enduring paralysis and irreversible neuronal damage. Extradural decompression of osseous as well as soft tissue components has historically been the principal objective of surgical procedures. Nevertheless, this particular surgical procedure fails to tackle the intradural compressive alterations that contribute to secondary SCI. Here, we propose an early intrathecal decompression strategy and evaluate its role on function outcome, tissue sparing, inflammation, and tissue stiffness after SCI. Durotomy surgery significantly promoted recovery of hindlimb locomotor function in an open-field test. Radiological analysis suggested that lesion size and tissue edema were significantly reduced in animals that received durotomy. Relative to the group with laminectomy alone, the animals treated with a durotomy had decreased cavitation, scar formation, and inflammatory responses at 4 weeks after SCI. An examination of the mechanical properties revealed that durotomy facilitated an expeditious restoration of the injured tissue's elastic rigidity. In general, early decompressive durotomy could serve as a significant strategy to mitigate the impairments caused by secondary injury and establish a more conducive microenvironment for prospective cellular or biomaterial transplantation.
Collapse
Affiliation(s)
- Chen Jin
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of EducationOrthopaedic Department of Tongji HospitalSchool of MedicineTongji UniversityShanghaiChina
- Department of OrthopedicsTongren HospitalShanghai Jiaotong University School of MedicineShanghaiChina
| | - Kaiwei Wang
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of EducationOrthopaedic Department of Tongji HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - Yilong Ren
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of EducationOrthopaedic Department of Tongji HospitalSchool of MedicineTongji UniversityShanghaiChina
- Department of OrthopedicsShanghai General HospitalShanghai Jiaotong University School of MedicineShanghaiChina
| | - Yi Li
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of EducationOrthopaedic Department of Tongji HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - Zhanwei Wang
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of EducationOrthopaedic Department of Tongji HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - Liming Cheng
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of EducationOrthopaedic Department of Tongji HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - Ning Xie
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of EducationOrthopaedic Department of Tongji HospitalSchool of MedicineTongji UniversityShanghaiChina
| |
Collapse
|
3
|
Jeffery ND, Rossmeisl JH, Harcourt-Brown TR, Granger N, Ito D, Foss K, Chase D. Randomized Controlled Trial of Durotomy as an Adjunct to Routine Decompressive Surgery for Dogs With Severe Acute Spinal Cord Injury. Neurotrauma Rep 2024; 5:128-138. [PMID: 38414780 PMCID: PMC10898236 DOI: 10.1089/neur.2023.0129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Abstract
Although many interventions for acute spinal cord injury (SCI) appear promising in experimental models, translation directly from experimental animals to human patients is a large step that can be problematic. Acute SCI occurs frequently in companion dogs and may provide a model to ease translation. Recently, incision of the dura has been highlighted in both research animals and human patients as a means of reducing intraspinal pressure, with a view to improving perfusion of the injured tissue and enhancing functional recovery. Observational clinical data in humans and dogs support the notion that it may also improve functional outcome. Here, we report the results of a multi-center randomized controlled trial of durotomy as an adjunct to traditional decompressive surgery for treatment of severe thoracolumbar SCI caused by acute intervertebral disc herniation in dogs. Sample-size calculation was based on the proportion of dogs recovering ambulation improving from an expected 55% in the traditional surgery group to 70% in the durotomy group. Over a 3.5-year period, we enrolled 140 dogs, of which 128 had appropriate duration of follow-up. Overall, 65 (51%) dogs recovered ambulation. Recovery in the traditional decompression group was 35 of 62 (56%) dogs, and in the durotomy group 30 of 66 (45%) dogs, associated with an odds ratio of 0.643 (95% confidence interval: 0.320-1.292) and z-score of -1.24. This z-score indicates trial futility to reach the target 15% improvement over traditional surgery, and the trial was terminated at this stage. We conclude that durotomy is ineffective in improving functional outcome for severe acute thoracolumbar SCI in dogs. In the future, these data can be compared with similar data from clinical trials on duraplasty in human patients and will aid in determining the predictive validity of the "companion dog model" of acute SCI.
Collapse
Affiliation(s)
- Nick D. Jeffery
- Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas, USA
| | - John H. Rossmeisl
- Department of Small Animal Clinical Sciences, VA-MD College of Veterinary Medicine, Blacksburg, Virginia, USA
| | | | | | - Daisuke Ito
- Nihon University College of Bioresource Sciences Department of Veterinary Medicine, Fujisawa, Japan
| | - Kari Foss
- Department of Veterinary Clinical Medicine, University of Illinois Urbana–Champaign, Champaign, Illinois, USA
| | - Damian Chase
- Veterinary Specialists Aotearora, Auckland, New Zealand
| |
Collapse
|
4
|
Chen Y, Yang H, Xie N, Zhang S, Zou X, Deng C, Wang B, Li H, Ma X. Could extended laminectomy effectively prevent spinal cord injury due to spinal shortening after 3-column osteotomy? BMC Musculoskelet Disord 2023; 24:658. [PMID: 37592275 PMCID: PMC10436457 DOI: 10.1186/s12891-023-06751-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/25/2023] [Indexed: 08/19/2023] Open
Abstract
OBJECTIVE To explore whether the laminectomy extension can effectively prevent spinal cord injury (SCI) due to spinal shortening after 3-column osteotomy in goat models. METHODS A total of twenty healthy goats were included and done with 3-column osteotomy of T13 and L1 under the somatosensory evoked potential (SSEP) monitoring. The samples were divided into two groups. The first group underwent regular laminectomy while the second group underwent an extended laminectomy with an extra 10 mm-lamina cranial to L2. The SSEP measured after 3-column osteotomy was set as the baseline, and the SSEP decreased by 50% from the baseline amplitude and/or delayed by 10% relative to the baseline peak latency was set as positive results, which indicated spinal cord injury. The vertebral column was gradually shortened until the SSEP monitoring just did not show a positive result. The height of the initial osteotomy gap (the distance from the lower endplate of T12 to the upper endplate of L2), the shortened distance (△H), the number of spinal cord angulated and the changed angle of the spinal cord (△α) were measured and recorded in each group. Neurological function was evaluated by the Tarlov scores on day 2 postoperatively. RESULTS All the goats except one of the first group due to changes in the SSEP during the osteotomy were included and analyzed. In the first group, the height of the initial osteotomy segment and the safe shortening distances were 61.6 ± 2.6 mm and 35.2 ± 2.6 mm, respectively; the spinal cord of 5 goats was angulated (46.4 ± 6.6°), the other four goats were kinked and not angulated. In the second group, the height of the initial osteotomy segment and the safe shortening distances were 59.8 ± 1.5 mm and 43.3 ± 1.2 mm, respectively, and the spinal cord of ten goats were angulated (97.6 ± 7.2°). There was no significant difference in the height of the initial osteotomy segment between the two groups by using Independent-Samples T-Test, P = 0.095 (P > 0.05); there were significant difference in the safe shortening distance and the changed angle of the spinal cord between the two groups by using Independent-Samples T-Test (both [Formula: see text]H and [Formula: see text]α of P < 0.001), the difference between their mean were 8.1 mm and 51.2°. Significant difference was found in the number of spinal cord angulation between the two groups through Fisher's exact test (5/9 vs. 10/10, P = 0.033). CONCLUSIONS An additional resection of 10 mm-lamina cranial to L2 showed the satisfactory effect in alleviating SCI after 3-column osteotomy. Timely and appropriate extend laminectomy could be a promising therapeutic strategy for SCI attributable to facilitating spinal cord angulation rather than spinal cord kinking and increasing the safe shortening distance.
Collapse
Affiliation(s)
- Yuyue Chen
- Department of Orthopedics, General Hospital of Southern Theatre Command, 111 Liuhua Road, Guangzhou, 510010, People's Republic of China
| | - Haozhi Yang
- Department of Orthopedics, General Hospital of Southern Theatre Command, 111 Liuhua Road, Guangzhou, 510010, People's Republic of China
| | - Ningling Xie
- Department of Orthopedics, General Hospital of Southern Theatre Command, 111 Liuhua Road, Guangzhou, 510010, People's Republic of China
| | - Shuang Zhang
- Department of Orthopedics, General Hospital of Southern Theatre Command, 111 Liuhua Road, Guangzhou, 510010, People's Republic of China
| | - Xiaobao Zou
- Department of Orthopedics, General Hospital of Southern Theatre Command, 111 Liuhua Road, Guangzhou, 510010, People's Republic of China
| | - Chenfu Deng
- Department of Orthopedics, General Hospital of Southern Theatre Command, 111 Liuhua Road, Guangzhou, 510010, People's Republic of China
| | - Binbin Wang
- Department of Orthopedics, General Hospital of Southern Theatre Command, 111 Liuhua Road, Guangzhou, 510010, People's Republic of China
| | - Hengrui Li
- Department of Orthopedics, General Hospital of Southern Theatre Command, 111 Liuhua Road, Guangzhou, 510010, People's Republic of China
| | - Xiangyang Ma
- Department of Orthopedics, General Hospital of Southern Theatre Command, 111 Liuhua Road, Guangzhou, 510010, People's Republic of China.
| |
Collapse
|
5
|
Khaing ZZ, Chen JY, Safarians G, Ezubeik S, Pedroncelli N, Duquette RD, Prasse T, Seidlits SK. Clinical Trials Targeting Secondary Damage after Traumatic Spinal Cord Injury. Int J Mol Sci 2023; 24:3824. [PMID: 36835233 PMCID: PMC9960771 DOI: 10.3390/ijms24043824] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/06/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023] Open
Abstract
Spinal cord injury (SCI) often causes loss of sensory and motor function resulting in a significant reduction in quality of life for patients. Currently, no therapies are available that can repair spinal cord tissue. After the primary SCI, an acute inflammatory response induces further tissue damage in a process known as secondary injury. Targeting secondary injury to prevent additional tissue damage during the acute and subacute phases of SCI represents a promising strategy to improve patient outcomes. Here, we review clinical trials of neuroprotective therapeutics expected to mitigate secondary injury, focusing primarily on those in the last decade. The strategies discussed are broadly categorized as acute-phase procedural/surgical interventions, systemically delivered pharmacological agents, and cell-based therapies. In addition, we summarize the potential for combinatorial therapies and considerations.
Collapse
Affiliation(s)
- Zin Z. Khaing
- Department of Neurological Surgery, University of Washington, Seattle, WA 98195, USA
| | - Jessica Y. Chen
- Department of Bioengineering, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Gevick Safarians
- Department of Bioengineering, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Sohib Ezubeik
- Department of Bioengineering, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Nicolas Pedroncelli
- Department of Bioengineering, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Rebecca D. Duquette
- Department of Bioengineering, University of California Los Angeles, Los Angeles, CA 90095, USA
- Department of Biomedical Engineering, University of Texas at Austin, Austin, TX 78712, USA
| | - Tobias Prasse
- Department of Neurological Surgery, University of Washington, Seattle, WA 98195, USA
- Department of Orthopedics and Trauma Surgery, University of Cologne, 50931 Cologne, Germany
| | - Stephanie K. Seidlits
- Department of Bioengineering, University of California Los Angeles, Los Angeles, CA 90095, USA
- Department of Biomedical Engineering, University of Texas at Austin, Austin, TX 78712, USA
| |
Collapse
|
6
|
Gee CM, Kwon BK. Significance of spinal cord perfusion pressure following spinal cord injury: A systematic scoping review. J Clin Orthop Trauma 2022; 34:102024. [PMID: 36147378 PMCID: PMC9486559 DOI: 10.1016/j.jcot.2022.102024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/27/2022] [Accepted: 09/07/2022] [Indexed: 11/30/2022] Open
Abstract
This scoping review systematically reviewed relevant research to summarize the literature addressing the significance of monitoring spinal cord perfusion pressure (SCPP) in acute traumatic spinal cord injury (SCI). The objectives of the review were to (1) examine the nature of research in the field of SCPP monitoring in SCI, (2) summarize the key research findings in the field, and (3) identify research gaps in the existing literature and future research priorities. Primary literature searches were conducted using databases (Medline and Embase) and expanded searches were conducted by reviewing the references of eligible articles and searches of Scopus, Web of Science core collection, Google Scholar, and conference abstracts. Relevant data were extracted from the studies and synthesis of findings was guided by the identification of patterns across studies to identify key themes and research gaps within the literature. Following primary and expanded searches, a total of 883 articles were screened. Seventy-three articles met the review inclusion criteria, including 34 original research articles. Other articles were categorized as conference abstracts, literature reviews, systematic reviews, letters to the editor, perspective articles, and editorials. Key themes relevant to the research question that emerged from the review included the relationship between SCPP and neurological recovery, the safety of monitoring pressures within the intrathecal space, and methods of intervention to enhance SCPP in the setting of acute traumatic SCI. Original research that aims to enhance SCPP by targeting increases in mean arterial pressure or reducing pressure in the intrathecal space is reviewed. Further discussion regarding where pressure within the intrathecal space should be measured is provided. Finally, we highlight research gaps in the literature such as determining the feasibility of invasive monitoring at smaller centers, the need for a better understanding of cerebrospinal fluid physiology following SCI, and novel pharmacological interventions to enhance SCPP in the setting of acute traumatic SCI. Ultimately, despite a growing body of literature on the significance of SCPP monitoring following SCI, there are still a number of important knowledge gaps that will require further investigation.
Collapse
Affiliation(s)
- Cameron M. Gee
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Canada
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Canada
| | - Brian K. Kwon
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Canada
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Canada
| |
Collapse
|
7
|
Advances in monitoring for acute spinal cord injury: a narrative review of current literature. Spine J 2022; 22:1372-1387. [PMID: 35351667 DOI: 10.1016/j.spinee.2022.03.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 02/04/2022] [Accepted: 03/22/2022] [Indexed: 02/03/2023]
Abstract
Spinal cord injury (SCI) is a devastating condition that affects about 17,000 individuals every year in the United States, with approximately 294,000 people living with the ramifications of the initial injury. After the initial primary injury, SCI has a secondary phase during which the spinal cord sustains further injury due to ischemia, excitotoxicity, immune-mediated damage, mitochondrial dysfunction, apoptosis, and oxidative stress. The multifaceted injury progression process requires a sophisticated injury-monitoring technique for an accurate assessment of SCI patients. In this narrative review, we discuss SCI monitoring modalities, including pressure probes and catheters, micro dialysis, electrophysiologic measures, biomarkers, and imaging studies. The optimal next-generation injury monitoring setup should include multiple modalities and should integrate the data to produce a final simplified assessment of the injury and determine markers of intervention to improve patient outcomes.
Collapse
|
8
|
Streijger F, Kim KT, So K, Manouchehri N, Shortt K, Okon EB, Morrison C, Fong A, Gupta R, Brown AA, Tigchelaar S, Sun J, Liu E, Keung M, Daly CD, Cripton PA, Sekhon MS, Griesdale DE, Kwon BK. Duraplasty in Traumatic Thoracic Spinal Cord Injury: Impact on Spinal Cord Hemodynamics, Tissue Metabolism, Histology, and Behavioral Recovery Using a Porcine Model. J Neurotrauma 2021; 38:2937-2955. [PMID: 34011164 DOI: 10.1089/neu.2021.0084] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
After acute traumatic spinal cord injury (SCI), the spinal cord can swell to fill the subarachnoid space and become compressed by the surrounding dura. In a porcine model of SCI, we performed a duraplasty to expand the subarachnoid space around the injured spinal cord and evaluated how this influenced acute intraparenchymal hemodynamic and metabolic responses, in addition to histological and behavioral recovery. Female Yucatan pigs underwent a T10 SCI, with or without duraplasty. Using microsensors implanted into the spinal cord parenchyma, changes in blood flow (ΔSCBF), oxygenation (ΔPO2), and spinal cord pressure (ΔSCP) during and after SCI were monitored, alongside metabolic responses. Behavioral recovery was tested weekly using the Porcine Injury Behavior Scale (PTIBS). Thereafter, spinal cords were harvested for tissue sparing analyses. In both duraplasty and non-animals, the ΔSCP increased ∼5 mm Hg in the first 6 h post-injury. After this, the SCP appeared to be slightly reduced in the duraplasty animals, although the group differences were not statistically significant after controlling for injury severity in terms of impact force. During the first seven days post-SCI, the ΔSCBF or ΔPO2 values were not different between the duraplasty and control animals. Over 12 weeks, there was no improvement in hindlimb locomotion as assessed by PTIBS scores and no reduction in tissue damage at the injury site in the duraplasty animals. In our porcine model of SCI, duraplasty did not provide any clear evidence of long-term behavioral or tissue sparing benefit after SCI.
Collapse
Affiliation(s)
- Femke Streijger
- International Collaboration on Repair Discoveries, University of British Columbia (UBC), Vancouver, British Columbia, Canada
| | - Kyoung-Tae Kim
- International Collaboration on Repair Discoveries, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Korea.,Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Kitty So
- International Collaboration on Repair Discoveries, University of British Columbia (UBC), Vancouver, British Columbia, Canada
| | - Neda Manouchehri
- International Collaboration on Repair Discoveries, University of British Columbia (UBC), Vancouver, British Columbia, Canada
| | - Katelyn Shortt
- International Collaboration on Repair Discoveries, University of British Columbia (UBC), Vancouver, British Columbia, Canada
| | - Elena B Okon
- International Collaboration on Repair Discoveries, University of British Columbia (UBC), Vancouver, British Columbia, Canada
| | - Charlotte Morrison
- International Collaboration on Repair Discoveries, University of British Columbia (UBC), Vancouver, British Columbia, Canada
| | - Allan Fong
- International Collaboration on Repair Discoveries, University of British Columbia (UBC), Vancouver, British Columbia, Canada
| | - Rishab Gupta
- International Collaboration on Repair Discoveries, University of British Columbia (UBC), Vancouver, British Columbia, Canada
| | - Aysha Allard Brown
- International Collaboration on Repair Discoveries, University of British Columbia (UBC), Vancouver, British Columbia, Canada
| | - Seth Tigchelaar
- International Collaboration on Repair Discoveries, University of British Columbia (UBC), Vancouver, British Columbia, Canada
| | - Jenny Sun
- International Collaboration on Repair Discoveries, University of British Columbia (UBC), Vancouver, British Columbia, Canada
| | - Ella Liu
- International Collaboration on Repair Discoveries, University of British Columbia (UBC), Vancouver, British Columbia, Canada
| | - Martin Keung
- International Collaboration on Repair Discoveries, University of British Columbia (UBC), Vancouver, British Columbia, Canada
| | - Chris D Daly
- Vancouver Spine Surgery Institute, Department of Orthopaedics, and University of British Columbia (UBC), Vancouver, British Columbia, Canada
| | - Peter A Cripton
- International Collaboration on Repair Discoveries, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,School of Biomedical Engineering and Orthopedics, University of British Columbia (UBC), Vancouver, British Columbia, Canada
| | - Mypinder S Sekhon
- Division of Critical Care Medicine, Department of Medicine and Pharmacology and Therapeutics, Faculty of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Donald E Griesdale
- Division of Critical Care Medicine, Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Brian K Kwon
- International Collaboration on Repair Discoveries, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,Vancouver Spine Surgery Institute, Department of Orthopaedics, and University of British Columbia (UBC), Vancouver, British Columbia, Canada
| |
Collapse
|
9
|
Khaing ZZ, Cates LN, Dewees DM, Hyde JE, Gaing A, Birjandian Z, Hofstetter CP. Effect of Durotomy versus Myelotomy on Tissue Sparing and Functional Outcome after Spinal Cord Injury. J Neurotrauma 2020; 38:746-755. [PMID: 33121382 DOI: 10.1089/neu.2020.7297] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Various surgical strategies have been developed to alleviate elevated intraspinal pressure (ISP) following acute traumatic spinal cord injury (tSCI). Surgical decompression of either the dural (durotomy) or the dural and pial (myelotomy) lining of the spinal cord has been proposed. However, a direct comparison of these two strategies is lacking. Here, we compare the histological and functional effects of durotomy alone and durotomy plus myelotomy in a rodent model of acute thoracic tSCI. Our results indicate that tSCI causes local tissue edema and significantly elevates ISP (7.4 ± 0.3 mmHg) compared with physiological ISP (1.7 ± 0.4 mmHg; p < 0.001). Both durotomy alone and durotomy plus myelotomy effectively mitigate elevated local ISP (p < 0.001). Histological examination at 10 weeks after tSCI revealed that durotomy plus myelotomy promoted spinal tissue sparing by 13.7% compared with durotomy alone, and by 25.9% compared with tSCI-only (p < 0.0001). Both types of decompression surgeries elicited a significant beneficial impact on gray matter sparing (p < 0.01). Impressively, durotomy plus myelotomy surgery increased preservation of motor neurons by 174.3% compared with tSCI-only (p < 0.05). Durotomy plus myelotomy surgery also significantly promoted recovery of hindlimb locomotor function in an open-field test (p < 0.001). Interestingly, only durotomy alone resulted in favorable recovery of bladder and Ladder Walk performance. Combined, our data suggest that durotomy plus myelotomy following acute tSCI facilitates tissue sparing and recovery of locomotor function. In the future, biomarkers identifying spinal cord injuries that can benefit from either durotomy alone or durotomy plus myelotomy need to be developed.
Collapse
Affiliation(s)
- Zin Z Khaing
- Department of Neurological Surgery, The University of Washington, Seattle, Washington, USA
| | - Lindsay N Cates
- Department of Neurological Surgery, The University of Washington, Seattle, Washington, USA
| | - Dane M Dewees
- Department of Neurological Surgery, The University of Washington, Seattle, Washington, USA
| | - Jeffrey E Hyde
- Department of Neurological Surgery, The University of Washington, Seattle, Washington, USA
| | - Ashley Gaing
- Department of Neurological Surgery, The University of Washington, Seattle, Washington, USA
| | - Zeinab Birjandian
- Department of Neurological Surgery, The University of Washington, Seattle, Washington, USA
| | - Christoph P Hofstetter
- Department of Neurological Surgery, The University of Washington, Seattle, Washington, USA
| |
Collapse
|
10
|
Telemacque D, Zhu FZ, Ren ZW, Chen KF, Drepaul D, Yao S, Yang F, Qu YZ, Sun TF, Guo XD. Effects of durotomy versus myelotomy in the repair of spinal cord injury. Neural Regen Res 2020; 15:1814-1820. [PMID: 32246622 PMCID: PMC7513969 DOI: 10.4103/1673-5374.280304] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 07/08/2019] [Accepted: 09/03/2019] [Indexed: 11/04/2022] Open
Abstract
Current management for spinal cord injury aims to reduce secondary damage and recover sensation and movement. Acute spinal cord injury is often accompanied by spinal cord compartment syndrome. Decompression by durotomy and/or myelotomy attempts to relieve secondary damage by completelyrelieving the compression of the spinal cord, removing the necrotic tissue, decreasing edema, reducing hemorrhage, and improving blood circulation in the spinal cord. However, it is controversial whether durotomy and/or myelotomy after spinal cord injury are beneficial to neurological recovery. This review compares the clinical effects of durotomy with those of myelotomy in the treatment of spinal cord injury. We found that durotomy has been performed more than myelotomy in the clinic, and that durotomy may be safer and more effective than myelotomy. Durotomy performed in humans had positive effects on neurological function in 92.3% of studies in this review, while durotomy in animals had positive effects on neurological function in 83.3% of studies. Myelotomy procedures were effective in 80% of animal studies, but only one clinical study of myelotomy has reported positive results, of motor and sensory improvement, in humans. However, a number of new animal studies have reported that durotomy and myelotomy are ineffective for spinal cord injury. More clinical data, in the form of a randomized controlled study, are needed to understand the effectiveness of durotomy and myelotomy.
Collapse
Affiliation(s)
- Dionne Telemacque
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei Province, China
| | - Feng-Zhao Zhu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei Province, China
| | - Zheng-Wei Ren
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei Province, China
| | - Kai-Fang Chen
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei Province, China
| | - Deepak Drepaul
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei Province, China
| | - Sheng Yao
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei Province, China
| | - Fan Yang
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei Province, China
| | - Yan-Zheng Qu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei Province, China
| | - Ting-Fang Sun
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei Province, China
| | - Xiao-Dong Guo
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei Province, China
| |
Collapse
|
11
|
Zhao T, Xu K, Wu Q, Wang C, Xiao S, Li H, He T, Wang L, Li F, Chen Q. Duraplasty of PHBV/PLA/Col membranes promotes axonal regeneration by inhibiting NLRP3 complex and M1 macrophage polarization in rats with spinal cord injury. FASEB J 2020; 34:12147-12162. [PMID: 32686873 DOI: 10.1096/fj.202000190rr] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 06/21/2020] [Accepted: 06/29/2020] [Indexed: 12/20/2022]
Abstract
Duraplasty after decompression decreases the lesion size and scar formation, promoting better functional recovery, but the underlying mechanism has not been clarified. Here, we fabricated a series of poly(hydroxybutyrate-co-hydroxyvalerate)/polylactic acid/collagen (PHBV/PLA/Col) membranes and cultured them with VSC4.1 motor neurons. The material characteristics and in vitro biological characteristics were evaluated. In the subcutaneous implantation test, PHBV/PLA/COl scaffolds supported the cellular infiltration, microvasculature formation, and decreased CD86-positive macrophage aggregation. Following contusion spinal cord injury at T10 in Sprague-Dawley rats, durotomy was performed with allograft dura mater or PHBV/PLA or PHBV/PLA/Col membranes. At 3 days post-injury, Western blot assay showed decreased the expression of the NLRP3, ASC, cleaved-caspase-1, IL-1β, TNF-α, and CD86 expression but increased the expression of CD206. Immunofluorescence demonstrated that duraplasty with PHBV/PLA/Col membranes reduced the infiltration of CD86-positive macrophages in the lesion site, decreased the glial fibrillary acidic protein expression, and increased the expression of NF-200. Moreover, duraplasty with PHBV/PLA/Col membranes improved locomotor functional recovery at 8 weeks post-injury. Thus, duraplasty with PHBV/PLA/Col membranes decreased the glial scar formation and promoted axon growth by inhibiting inflammasome activation and modulating macrophage polarization in acute spinal cord injury.
Collapse
Affiliation(s)
- Tengfei Zhao
- Department of Orthopedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Kan Xu
- Department of Orthopedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qionghua Wu
- Department of Orthopedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chenggui Wang
- Department of Orthopedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shining Xiao
- Department of Orthopedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Heyangzi Li
- Department of Basic Medicine Sciences, Zhejiang University School of Medicine, Hangzhou, China.,Department of Orthopaedics of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Teng He
- Department of Basic Medicine Sciences, Zhejiang University School of Medicine, Hangzhou, China.,Department of Orthopaedics of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Linlin Wang
- Department of Basic Medicine Sciences, Zhejiang University School of Medicine, Hangzhou, China.,Department of Orthopaedics of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fangcai Li
- Department of Orthopedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qixin Chen
- Department of Orthopedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|