Jordan W Squair1, Lise M Bélanger1, Angela Tsang1, Leanna Ritchie1, Jean-Marc Mac-Thiong1, Stefan Parent1, Sean Christie1, Christopher Bailey1, Sanjay Dhall1, Raphaele Charest-Morin1, John Street1, Tamir Ailon1, Scott Paquette1, Nicolas Dea1, Charles G Fisher1, Marcel F Dvorak1, Christopher R West1, Brian K Kwon2. 1. From the International Collaboration on Repair Discoveries (J.W.S., C.R.W., B.K.K.); MD/PhD Training Program (J.W.S.), School of Kinesiology (C.R.W.), and Department of Orthopaedics (R.C.-M., J.S., T.A., S. Paquette, N.D., C.G.F., M.F.D.), University of British Columbia; Vancouver Spine Program (L.M.B., A.T., L.R.), Vancouver General Hospital, British Columbia; Department of Surgery (J.-M.M.-T., S. Parent), Hôpital du Sacré-Coeur de Montréal, and Chu Sainte-Justine (S.C.), Department of Surgery, Université de Montréal, Quebec; Division of Orthopaedic Surgery (C.B.), London Health Sciences Centre, University of Western Ontario, Canada; Department of Neurological Surgery (S.D.), University of California, San Francisco; Vancouver Spine Surgery Institute (R.C.-M., J.S., T.A., S. Paquette, N.D., C.G.F., M.F.D., B.K.K.); and Division of Neurosurgery (B.K.K.), University of British Columbia, Blusson Spinal Cord Centre, Vancouver, Canada. 2. From the International Collaboration on Repair Discoveries (J.W.S., C.R.W., B.K.K.); MD/PhD Training Program (J.W.S.), School of Kinesiology (C.R.W.), and Department of Orthopaedics (R.C.-M., J.S., T.A., S. Paquette, N.D., C.G.F., M.F.D.), University of British Columbia; Vancouver Spine Program (L.M.B., A.T., L.R.), Vancouver General Hospital, British Columbia; Department of Surgery (J.-M.M.-T., S. Parent), Hôpital du Sacré-Coeur de Montréal, and Chu Sainte-Justine (S.C.), Department of Surgery, Université de Montréal, Quebec; Division of Orthopaedic Surgery (C.B.), London Health Sciences Centre, University of Western Ontario, Canada; Department of Neurological Surgery (S.D.), University of California, San Francisco; Vancouver Spine Surgery Institute (R.C.-M., J.S., T.A., S. Paquette, N.D., C.G.F., M.F.D., B.K.K.); and Division of Neurosurgery (B.K.K.), University of British Columbia, Blusson Spinal Cord Centre, Vancouver, Canada. brian.kwon@ubc.ca.
Abstract
OBJECTIVE: To determine the hemodynamic conditions associated with optimal neurologic improvement in individuals with acute traumatic spinal cord injury (SCI) who had lumbar intrathecal catheters placed to measure CSF pressure (CSFP). METHODS: Ninety-two individuals with acute SCI were enrolled in this multicenter prospective observational clinical trial. We monitored mean arterial pressure (MAP) and CSFP during the first week after injury and assessed neurologic function at baseline and 6 months after injury. We used relative risk iterations to determine transition points at which the likelihood of either improving neurologically or remaining unchanged neurologically was equivalent. These transition points guided our analyses in which we examined the linear relationships between time spent within target hemodynamic ranges (i.e., clinical adherence) and neurologic recovery. RESULTS: Relative risk transition points for CSFP, MAP, and spinal cord perfusion pressure (SCPP) were linearly associated with neurologic improvement and directed the identification of key hemodynamic target ranges. Clinical adherence to the target ranges was positively and linearly related to improved neurologic outcomes. Adherence to SCPP targets, not MAP targets, was the best indicator of improved neurologic recovery, which occurred with SCPP targets of 60 to 65 mm Hg. Failing to maintain the SCPP within the target ranges was an important detrimental factor in neurologic recovery, particularly if the target range is set lower. CONCLUSION: We provide an empirical, data-driven approach to aid institutions in setting hemodynamic management targets that accept the real-life challenges of adherence to specific targets. Our results provide a framework to guide the development of widespread institutional management guidelines for acute traumatic SCI.
OBJECTIVE: To determine the hemodynamic conditions associated with optimal neurologic improvement in individuals with acute traumatic spinal cord injury (SCI) who had lumbar intrathecal catheters placed to measure CSF pressure (CSFP). METHODS: Ninety-two individuals with acute SCI were enrolled in this multicenter prospective observational clinical trial. We monitored mean arterial pressure (MAP) and CSFP during the first week after injury and assessed neurologic function at baseline and 6 months after injury. We used relative risk iterations to determine transition points at which the likelihood of either improving neurologically or remaining unchanged neurologically was equivalent. These transition points guided our analyses in which we examined the linear relationships between time spent within target hemodynamic ranges (i.e., clinical adherence) and neurologic recovery. RESULTS: Relative risk transition points for CSFP, MAP, and spinal cord perfusion pressure (SCPP) were linearly associated with neurologic improvement and directed the identification of key hemodynamic target ranges. Clinical adherence to the target ranges was positively and linearly related to improved neurologic outcomes. Adherence to SCPP targets, not MAP targets, was the best indicator of improved neurologic recovery, which occurred with SCPP targets of 60 to 65 mm Hg. Failing to maintain the SCPP within the target ranges was an important detrimental factor in neurologic recovery, particularly if the target range is set lower. CONCLUSION: We provide an empirical, data-driven approach to aid institutions in setting hemodynamic management targets that accept the real-life challenges of adherence to specific targets. Our results provide a framework to guide the development of widespread institutional management guidelines for acute traumatic SCI.
Authors: Carl Moritz Zipser; José Miguel Spirig; José Aguirre; Anna-Sophie Hofer; Nikolai Pfender; Markus Hupp; Armin Curt; Mazda Farshad; Martin Schubert Journal: Acta Neurochir Suppl Date: 2021
Authors: Matthieu Gautier; Lois Mahe; Jan Elaine Soriano; Andreas Rowald; Jordan W Squair; Arnaud Bichat; Newton Cho; Mark A Anderson; Nicholas D James; Jerome Gandar; Anthony V Incognito; Giuseppe Schiavone; Zoe K Sarafis; Achilleas Laskaratos; Kay Bartholdi; Robin Demesmaeker; Salif Komi; Charlotte Moerman; Bita Vaseghi; Berkeley Scott; Ryan Rosentreter; Claudia Kathe; Jimmy Ravier; Laura McCracken; Xiaoyang Kang; Nicolas Vachicouras; Florian Fallegger; Ileana Jelescu; YunLong Cheng; Qin Li; Rik Buschman; Nicolas Buse; Tim Denison; Sean Dukelow; Rebecca Charbonneau; Ian Rigby; Steven K Boyd; Philip J Millar; Eduardo Martin Moraud; Marco Capogrosso; Fabien B Wagner; Quentin Barraud; Erwan Bezard; Stéphanie P Lacour; Jocelyne Bloch; Grégoire Courtine; Aaron A Phillips Journal: Nature Date: 2021-01-27 Impact factor: 49.962
Authors: Troy Q Tabarestani; Nicholle E Lewis; Margot Kelly-Hedrick; Nina Zhang; Brianna R Cellini; Eric J Marrotte; Theresa Williamson; Haichen Wang; Daniel T Laskowitz; Timothy D Faw; Muhammad M Abd-El-Barr Journal: Neurospine Date: 2022-09-30
Authors: Nicholle E Lewis; Troy Q Tabarestani; Brianna R Cellini; Nina Zhang; Eric J Marrotte; Haichen Wang; Daniel T Laskowitz; Muhammad M Abd-El-Barr; Timothy D Faw Journal: Neurospine Date: 2022-09-30
Authors: Carlos A Almeida; Abel Torres-Espin; J Russell Huie; Dongming Sun; Linda J Noble-Haeusslein; Wise Young; Michael S Beattie; Jacqueline C Bresnahan; Jessica L Nielson; Adam R Ferguson Journal: Neuroinformatics Date: 2021-03-02