Mitigating the spinal cord distraction injury: the in-vitro effect of durotomy and longitudinal cordotomy in decreasing cord interstitial pressure
Journal Article
W, Awwad, . 2014
Publication Work Type:
Original Article
Publication Online URL:
Magazine \ Newspaper:
EJOS
Publication Abstract:
Study design The present study involved an in vitro
examination of spinal cord interstitial pressure (CIP) during
distraction before and after durotomy in three spinal
cord segments obtained from five pigs.
Objectives To determine whether durotomy can be used
to decrease the elevated CIP associated with spinal cord
distraction.
Summary of background data Spinal cord distraction is a
known cause of spinal cord injury. Several articles
describing the pathophysiology of cord distraction injuries
suggest that the underlying mechanism of injury is a
microvascular ischemic event. The authors have previously
described an increase in CIP with spinal cord distraction,
with average pressures of 23 mmHg at loads of 1,000 g. To
date, there are no published studies that have evaluated the
efficacy of intentional durotomies as a treatment for elevated
CIP.
Methods A total of 15 spinal cord sections were harvested
from pigs and distracted while immersed in saline, using a
fixed 1,000 g distraction force. The CIP decay was then
measured at 30-s intervals for 10 min. The distraction/
relaxation maneuver was performed six times with continuous
CIP monitoring and was subsequently followed by
durotomy.
Results The pressure–decay curves were similar for each
specimen, but varied according to individual pigs and
anatomical levels. CIP decayed over the first 4 min of
distraction and remained constant for the final 6 min.
Longitudinal durotomy led to a dramatic drop in CIP
toward baseline and appeared to be as effective as transverse
durotomy with regard to the normalization of
pressure.
Conclusion Spinal cord distraction causes elevations in
CIP. Durotomy lowers elevated CIP in vitro and may be
effective at lowering CIP in vivo. Further study is required
to evaluate the usefulness of durotomy in vivo.