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Abstract

Introduction

Acute, severe traumatic spinal cord injury (TSCI) is a catastrophic event. No effective treatment exists for the primary neurological injury. Detecting and treating secondary neurological injury, however, is feasible, and may improve neurological outcome. This thesis contains three studies utilising injury site monitoring, translating to novel applications in the clinical management of TSCI.

Research Aims

(i) To develop a novel technique to monitor tissue oxygen in TSCI
(ii) To test the hypothesis that infective, inflammatory, and neurogenic fevers are detrimental
(iii) To test the hypothesis that spinal cord perfusion pressure (SCPP) affects breathing function in patients with cervical TSCI

Methods

Patients sustaining acute, severe TSCI within 72 hours, underwent cervical decompression (posterior +/- metalwork fixation +/- anterior surgery). Simultaneously, microsurgical insertion of subdural pressure and microdialysis probes (+/- oxygen electrode +/- lumbar drain) was performed. Multimodality data were acquired from the injury site on neuro-intensive care for up to one week. Relevant clinical assessments were obtained during monitoring and follow-up.

Results

The key findings are, that following acute TSCI:
(i) It is feasible to monitor spinal cord tissue oxygen (psctO2) from the injury site. psctO2 is a key parameter, associated with injury site physiology, metabolism, and neurologic outcome.
(ii) Deranged injury site metabolism defines all three major types of fever (neurogenic, inflammatory and infective). Therefore, all are likely harmful. Specific clinical features of different fever types can be exploited to distinguish neurogenic from non-neurogenic fever.
(iii) Monitoring breathing function using ultrasound and diaphragmatic EMG, is feasible and reproducible. SCPP correlates with breathing function, cord hypo-perfusion and hyper-perfusion being detrimental. SCPP 80 – 90 mmHg correlates with improved diaphragmatic and intercostal muscle contractility.

Conclusions

Multimodality monitoring following TSCI is feasible and safe. Improving injury site psctO2, restoring normothermia and optimising breathing function, may minimise secondary neurological injury to enhance neurological recovery.

Publication Type:	Thesis (Doctoral)
Subjects:	Q Science > Q Science (General) R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
Departments:	School of Health & Medical Sciences > Neuroscience and Cell Biology Research Institute School of Health & Medical Sciences > School of Health & Medical Sciences Doctoral Theses Doctoral Theses

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