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.
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.
Authors: Joshua M Pahys; James T Guille; Linda P D'Andrea; Amer F Samdani; Joshua Beck; Randal R Betz Journal: J Am Acad Orthop Surg Date: 2009-07 Impact factor: 3.020