Retrospective Analysis of Expansile Duraplasty as Surgical Adjunct After Acute Traumatic Spinal Cord Injury

Study DesignRetrospective single-center review.ObjectivesAssess whether expansile duraplasty was associated with greater motor recovery in patients with acute traumatic spinal cord injury (tSCI) compared with bony decompression alone.MethodsRetrospective chart review was conducted for patients who underwent surgical stabilization and decompression for tSCI at a level-1 trauma center. Changes in motor scores were calculated and compared between patients who had expansile duraplasty and those who did not.ResultsWe studied 96 patients: 11 who underwent expansile duraplasty and 85 who did not. The average pre-operative motor scores for patients with duraplasty was 33.3 ± 22.5 compared to 49.0 ± 29.3 for non-duraplasty (P = 0.11). At hospital discharge the duraplasty group had an average motor score of 43.1 ± 26.3 with an average score of 52.9 ± 29.4 for the non-duraplasty group (P = 0.41). The average motor score at the time of inpatient rehabilitation discharge was 55.3 ± 28.6 for duraplasty and 60.1 ± 30.3 for non-duraplasty (P = 0.37). The change in motor score between baseline and hospital discharge was 9.8 ± 11.8 for duraplasty and 3.9 ± 11.4 for controls (P = 0.088). There was a higher change in motor score from baseline to inpatient rehabilitation discharge in the duraplasty group (20.3 ± 11.6 vs 11.1 ± 13.5 for controls, P = 0.034) even after adjusting for covariates through inverse probability weighting (P = 0.017). The duraplasty group did not have significantly more complications.ConclusionsPatients who underwent expansile duraplasty at the time of surgical stabilization and decompression for acute tSCI had greater motor improvement between preoperative evaluation and rehabilitation discharge than patients without duraplasty. This technique warrants further study in a multi-center, prospective study.