Cerebrospinal Fluid Drainage in Patients with Acute Spinal Cord Injury: A Multi-Center Randomized Controlled Trial

Area of Science:

• Neurosurgery
• Neurology
• Critical Care Medicine

Background:

• The secondary phase of spinal cord injury (SCI) involves ischemic injury, making spinal cord perfusion pressure (SCPP) a critical therapeutic target.
• Spinal cord perfusion pressure (SCPP) is calculated as mean arterial pressure (MAP) minus intrathecal pressure (ITP).
• Cerebrospinal fluid drainage (CSFD) is a potential method to decrease ITP and enhance SCPP.

Purpose of the Study:

• To evaluate the safety and feasibility of CSFD in improving SCPP and patient outcomes following acute SCI.
• To assess the impact of CSFD on reducing intrathecal pressure (ITP) in acute SCI patients.

Main Methods:

• A randomized controlled trial involving patients with acute cervical SCI within 24 hours of presentation.
• Patients received either MAP elevation alone (control) or MAP elevation combined with CSFD to maintain ITP below 10 mmHg for 5 days.
• Hourly monitoring of ITP and MAP, with functional assessments at multiple time points post-injury.

Main Results:

• CSFD significantly reduced mean ITP (5.3 ± 2.5 mmHg) compared to the control group (15 ± 3.0 mmHg).
• SCPP improved significantly in the CSFD group (101 ± 6.3 mmHg) versus the control group (77 ± 4.5 mmHg).
• Total motor scores improved substantially more in the CSFD group (57 ± 24 points) than in the control group (15 ± 8.4 points) over 180 days.

Conclusions:

• CSFD is a safe and effective intervention for reducing ITP and improving SCPP in the acute phase after SCI.
• The favorable safety profile and preliminary efficacy of CSFD warrant further investigation in larger studies.
• CSFD shows promise for improving functional outcomes in patients with acute SCI.