Cerebrospinal Fluid Pressure Dynamics as a Bedside Test in Traumatic Spinal Cord Injury to Assess Surgical Spinal Cord Decompression: Safety, Feasibility, and Proof-of-Concept

Neurorehabilitation and Neural Repair, 2023 · DOI: 10.1177/15459683231159662 · Published: April 1, 2023

Simple Explanation

This study explores the use of cerebrospinal fluid pressure (CSFP) measurements as a simple test to check for remaining spinal cord compression after surgery in patients with spinal cord injury (SCI). The goal is to see if this test is safe, practical, and helpful in identifying patients who might need further surgery. The researchers measured CSFP in patients with SCI after they had surgery to relieve pressure on the spinal cord. They used techniques like the Valsalva maneuver and Queckenstedt’s test to assess how the CSFP changes under different conditions. The study found that measuring CSFP is safe and can reveal signs of ongoing spinal cord compression. This information could potentially help doctors decide if additional surgery is needed to improve a patient's recovery.

Study Duration

2020 and 2022

Participants

N = 9 with mostly cervical acute-subacute SCI and N = 2 patients with non-traumatic SCI

Evidence Level

Prospective cohort study

Key Findings

1
Comprehensive bedside lumbar CSFP dynamics in SCI following decompression are safe, feasible, and can reveal distinct patterns of residual spinal cord compression.
2
CSFPp was reduced in 3 patients compared to a spine-healthy cohort, indicative of restricted CSF circulation.
3
Patients with cervical SCI commonly had reduced response to Valsalva maneuver, which was related to reduced abdominal and thoracic muscle force.

Research Summary

This study investigated the safety and feasibility of using cerebrospinal fluid pressure (CSFP) dynamics as a bedside test to assess surgical spinal cord decompression in patients with spinal cord injury (SCI). The researchers found that CSFP dynamics measurements are safe and feasible, and they can reveal distinct patterns of residual spinal cord compression following surgical decompression. The study suggests that CSFP dynamics can be a useful tool in identifying patients who may benefit from further surgical interventions and in evaluating the effectiveness of intrathecal drug administration in clinical trials.

Practical Implications

Improved Assessment of Decompression

CSFP dynamics can serve as a bedside tool to assess the adequacy of spinal cord decompression after surgery, potentially reducing the need for more complex imaging techniques.

Personalized Treatment Strategies

Identifying patients with residual cord compression through CSFP assessments may allow for tailored treatment plans, including surgical revisions or adjustments to intrathecal drug delivery.

Enhanced Clinical Trial Design

Incorporating CSFP assessments in clinical trials evaluating intrathecal therapies for SCI can help identify patients with compromised CSF circulation, leading to more accurate evaluation of treatment efficacy.

Study Limitations

1
Small sample size limits generalizability of findings.
2
Valsalva maneuver execution was pragmatic without respiratory monitoring.
3
Potential confounders to CSFP dynamics such as arterial blood pressure, BMI, or age were not systematically analyzed.

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