Targeted Perfusion Therapy in Spinal Cord Trauma

Area of Science:

• Neuroscience
• Intensive Care Medicine
• Neurosurgery

Background:

• Acute severe traumatic spinal cord injury (TSCI) management traditionally uses generalized mean arterial pressure targets.
• Monitoring techniques for TSCI are evolving, drawing parallels with traumatic brain injury (TBI) management.
• Understanding intraspinal pressure and spinal cord perfusion pressure (SCPP) is crucial for targeted therapy.

Purpose of the Study:

• To review advanced monitoring techniques for acute TSCI.
• To introduce concepts like spinal cord autoregulation and the spinal pressure reactivity index (sPRx).
• To advocate for individualized SCPP management based on real-time monitoring.

Main Methods:

• Review of state-of-the-art monitoring techniques for TSCI.
• Discussion of intraspinal pressure, SCPP, and spinal cord autoregulation (quantified by sPRx).
• Analysis of multimodality monitoring data correlating SCPP with injury site metabolism and blood flow.

Main Results:

• Optimal SCPP, defined by minimized sPRx, varies between patients and over time, suggesting a U-shaped relationship.
• Strong correlations exist between SCPP and tissue metabolism (glucose, lactate, pyruvate, glutamate, glycerol) at the injury site.
• Expansion duroplasty is proposed as a novel treatment for spinal cord compression post-TSCI.
• Monitoring revealed distinct blood flow patterns, including local steal and diastolic ischemia.

Conclusions:

• Monitoring the injured spinal cord in the ICU is safe and feasible.
• Individualized SCPP management, guided by sPRx and metabolic monitoring, can optimize perfusion.
• Further research into novel treatments like expansion duroplasty is warranted.