Clinical Studies Examining Intrathecal Drainage for Acute Traumatic Spinal Cord Injury: A Living Systematic Review

Area of Science:

• Neurosurgery
• Neurology
• Critical Care Medicine

Background:

• Traumatic spinal cord injury (TSCI) leads to significant disability.
• Lumbar cerebrospinal fluid (CSF) drainage is standard for aortic aneurysm surgery but understudied in acute TSCI.
• Intrathecal CSF drainage aims to reduce intrathecal pressure (ITP) and improve outcomes in TSCI.

Purpose of the Study:

• To evaluate the safety and feasibility of intrathecal CSF drainage in acute TSCI.
• To assess the impact of CSF drainage on clinical indices and neurological recovery.
• To identify the need for further research in managing acute TSCI.

Main Methods:

• Living systematic review of literature from database inception to March 2024.
• Included 2 randomized controlled studies and 1 cohort study.
• Analyzed data on CSF drainage techniques, intrathecal pressure (ITP) management, and patient outcomes.

Main Results:

• Intrathecal CSF drainage was demonstrated as feasible and safe in three small studies (11-22 patients).
• Drainage occurred 10-72 hours post-injury with varying ITP targets (<10 mmHg).
• Observed improvements in spinal cord perfusion and trends toward better neurological recovery.

Conclusions:

• Intrathecal CSF drainage is a safe and feasible intervention in the acute phase of TSCI.
• Evidence suggests potential benefits for spinal cord perfusion and neurological outcomes.
• Larger prospective trials are crucial to confirm efficacy and optimize multimodal treatment strategies for TSCI.