The Incidence of Neurogenic Shock after Spinal Cord Injury in Patients Admitted to a High-Volume Level I Trauma Center

Abstract BACKGROUND While the utilization of neurophysiologic intraoperative monitoring with motor evoked potentials (MEPs) has become widespread in surgery for traumatic spine fractures and spinal cord injury (SCI), clinical validation of its diagnostic and therapeutic benefit has been limited. OBJECTIVE To describe the use of intraoperative MEP at a large level I trauma center and assess the prognostic capability of this technology. METHODS The SCI REDCap database at our institution, a level I trauma center, was queried for acute cervical SCI patients who underwent surgery with intraoperative monitoring between 2005 and 2011, yielding 32 patients. Of these, 23 patients had severe SCI (association impairment scale [AIS] A, B, C). We assessed preoperative and postoperative SCI severity (AIS grade), surgical data, use of steroids, and early magnetic resonance imaging (MRI) findings (preoperatively in 27 patients), including axial T2 MRI grade (Brain and Spinal Injury Center score). RESULTS The presence of MEPs significantly predicted AIS at discharge (P< .001). In the group of severe SCI (ie, AIS A, B, C) patients with elicitable MEPs, AIS improved by an average of 1.5 grades (median = 1), as compared to the patients without elicitable MEP who improved on average 0.5 grades (median = 0, P< .05). In addition, axial MRI grade significantly correlated with MEP status. Patients without MEPs had a significantly higher axial MRI grade in comparison to the patients with MEPs (P< .001). CONCLUSION In patients with severe SCI, MEPs predicted neurological improvement and correlated with axial MRI grade. These significant findings warrant future prospective studies of MEPs as a prognostic tool in SCI.

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Initial Experience of Spinal Cord Perfusion Pressure Goals in Lieu of Mean Arterial Pressure Goals in Acute Traumatic Spinal Cord Injury at a United States Level I Trauma Center: A Transforming Research and Clinical Knowledge-Spinal Cord Injury Study

Neurosurgery ◽

10.1093/neuros/nyz310_444 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

John K Yue ◽

Debra P Hemmerle ◽

Hansen Deng ◽

Ethan A Winkler ◽

Leigh H Thomas ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Trauma Center ◽

Perfusion Pressure ◽

Standard Of Care ◽

Traumatic Spinal Cord Injury ◽

Initial Experience ◽

Clinical Knowledge ◽

Cord Injury ◽

Level I

Abstract INTRODUCTION Management of traumatic spinal cord injury (SCI) includes urgent decompression and decreasing secondary injury through blood pressure augmentation. Mean arterial pressure (MAP) targets have been the standard of care for decades, however recent clinical trial data have demonstrated the relationship between spinal cord perfusion pressure (SCPP) and neurologic recovery. These data led to implementation of a novel standard of care protocol at our institution focused on SCPP, in lieu of MAP goals. We provide the initial experience of implementation of protocolized SCPP goals for acute SCI at a US level I trauma center. METHODS Starting December 2017, all moderate/severe blunt SCI patients at our institution presenting < 24 h of injury received lumbar subarachnoid drain placement (LSAD) for intraspinal pressure (ISP) and SCPP monitoring in the neurological intensive care unit (NICU), and were included in the Transforming Research and Clinical Knowledge in Spinal Cord Injury (TRACK-SCI) data registry. This is known as the SCPP Protocol, and comprises standard care at our institution. SCPPs were monitored for 5 d with goal = 65 mmHg achieved through intravenous fluids and vasopressor support. American Spinal Injury Association Impairment Scale (AIS) grades were assessed at admission and day 7. RESULTS In 15 patients enrolled to date, age was 60.5 ± 17.0 yr and 46.7% were = 65. Injury level was 93.3% cervical and 6.7% thoracic. Admission AIS were 20.0%/20.0%/26.7%/33.3% for A/B/C/D, respectively. A total of 14 patients underwent surgical decompression with time to surgery 8.8 ± 7.1 h and 71.4% < 12 h. Hospital length of stay (LOS) was 14.7 ± 8.3 d. NICU LOS was 11.5 ± 8.9 d. No patient had lumbar drain-related complications. Seven patients had respiratory complications and 1 expired after family transitioned to comfort care. AIS grade improvement of 1 occurred in one-third of patients (2 AIS = B, 3 AIS = C). CONCLUSION In our initial experience of 15 patients with acute traumatic SCI, standardized SCPP goal-directed care through lumbar ISP monitoring for the first 5 d postinjury was feasible and without SCPP-related complications.

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Early versus delayed decompression in acute subaxial cervical spinal cord injury: A prospective outcome study at a Level I trauma center from India

Asian Journal of Neurosurgery ◽

10.4103/1793-5482.161193 ◽

2015 ◽

Vol 10 (3) ◽

pp. 158 ◽

Cited By ~ 3

Author(s):

DeepakKumar Gupta ◽

Saquib Siddiqui ◽

Chhavi Sawhney ◽

Atin Kumar ◽

S.S. Kale ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Trauma Center ◽

Cervical Spinal Cord ◽

Cervical Spinal Cord Injury ◽

Outcome Study ◽

Cord Injury ◽

Level I

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High-Dose Methylprednisolone for Acute Closed Spinal Cord Injury - Only a Treatment Option

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100001992 ◽

2002 ◽

Vol 29 (3) ◽

pp. 227-235 ◽

Cited By ~ 80

Author(s):

H. Hugenholtz ◽

D.E. Cass ◽

M.F. Dvorak ◽

D.H. Fewer ◽

R.J. Fox ◽

...

Keyword(s):

Systematic Review ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Treatment Option ◽

Spinal Cord Injuries ◽

High Dose ◽

Cochrane Systematic Review ◽

High Dose Methylprednisolone ◽

Cord Injury ◽

Level I

Background:A systematic review of the evidence pertaining to methylprednisolone infusion following acute spinal cord injury was conducted in order to address the persistent confusion about the utility of this treatment.Methods:A committee of neurosurgical and orthopedic spine specialists, emergency physicians and physiatrists engaged in active clinical practice conducted an electronic database search for articles about acute spinal cord injuries and steroids, from January 1, 1966 to April 2001, that was supplemented by a manual search of reference lists, requests for unpublished additional information, translations of foreign language references and study protocols from the author of a Cochrane systematic review and Pharmacia Inc. The evidence was graded and recommendations were developed by consensus.Results:One hundred and fifty-seven citations that specifically addressed spinal cord injuries and methylprednisolone were retrieved and 64 reviewed. Recommendations were based on one Cochrane systematic review, six Level I clinical studies and seven Level II clinical studies that addressed changes in neurological function and complications following methylprednisolone therapy.Conclusion:There is insufficient evidence to support the use of high-dose methylprednisolone within eight hours following an acute closed spinal cord injury as a treatment standard or as a guideline for treatment. Methylprednisolone, prescribed as a bolus intravenous infusion of 30 mg per kilogram of body weight over fifteen minutes within eight hours of closed spinal cord injury, followed 45 minutes later by an infusion of 5.4 mg per kilogram of bodyweight per hour for 23 hours, is only a treatment option for which there is weak clinical evidence (Level I- to II-1). There is insufficient evidence to support extending methylprednisolone infusion beyond 23 hours if chosen as a treatment option.

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Association Between Trauma Center Designation and Spinal Cord Injury Admission in the USA

Journal of Neurology Research ◽

10.14740/jnr609 ◽

2020 ◽

Vol 10 (5) ◽

pp. 193-198

Author(s):

Ross-Jordon S. Elliott ◽

Anand Dharia ◽

Ali Seifi

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Trauma Center ◽

Cord Injury ◽

The Usa

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Acute Traumatic Spinal Cord Injury in Humans, Dogs, and Other Mammals: The Under-appreciated Role of the Dura

Frontiers in Neurology ◽

10.3389/fneur.2021.629445 ◽

2021 ◽

Vol 12 ◽

Author(s):

Samira Saadoun ◽

Nicolas D. Jeffery

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Animal Studies ◽

Cord Compression ◽

Intervertebral Disc Herniation ◽

Functional Benefit ◽

Number Of Patients ◽

Cord Injury ◽

Level I ◽

Set Up

We review human and animal studies to determine whether, after severe spinal cord injury (SCI), the cord swells against the inelastic dura. Evidence from rodent models suggests that the cord swells because of edema and intraparenchymal hemorrhage and because the pia becomes damaged and does not restrict cord expansion. Human cohort studies based on serial MRIs and measurements of elevated intraspinal pressure at the injury site also suggest that the swollen cord is compressed against dura. In dogs, SCI commonly results from intervertebral disc herniation with evidence that durotomy provides additional functional benefit to conventional (extradural) decompressive surgery. Investigations utilizing rodent and pig models of SCI report that the cord swells after injury and that durotomy is beneficial by reducing cord pressure, cord inflammation, and syrinx formation. A human MRI study concluded that, after extensive bony decompression, cord compression against the dura may only occur in a small number of patients. We conclude that the benefit of routinely opening the dura after SCI is only supported by animal and level III human studies. Two randomized, controlled trials, one in humans and one in dogs, are being set up to provide Level I evidence.

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