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Abstract

Background

Acute, severe traumatic spinal cord injury (TSCI) is devastating, resulting in paralysis and bladder/bowel incontinence. No treatment improves outcomes.

Aims

We recruited patients with TSCI to determine whether:

1) Pre-operative biomarkers can predict intraspinal pressure (ISP) and optimal spinal cord perfusion pressure (SCPPopt).
2) Monitoring the lumbar cerebrospinal fluid (CSF) space is analogous to monitoring the injury site.
3) Fluctuations in injury site physiological and metabolic parameters are causatively linked to changes in limb power.
4) Local hypothermia-rewarming alters injury site physiology, metabolism and inflammation.
5) Urinary bladder and anal sphincter function are influenced by fluctuations in injury site physiology and metabolism.

Methods

Patients with acute severe TSCI underwent surgical fixation and insertion of subdural ISP and microdialysis probes (+/- lumbar drain, +/- local cooling device). Injury site monitoring was performed on neuro-intensive care for up to a week. Clinical assessments were performed +/- urodynamic investigations, +/- anorectal manometry. A small cohort had local hypothermia-rewarming.

Results

Our key findings are:

1) Injury site physiology and metabolism cannot be predicted pre-operatively from clinical and radiological biomarkers.
2) ISP and lumbar CSF pressures are different.
3) Injury site physiology and metabolism are causally linked to fluctuations in limb power.
4) Most TSCI patients develop unfavourable urodynamics which are influenced by injury site physiology and metabolism.
5) Anal sphincter function is influenced by changes in SCPP.
6) Local hypothermia-rewarming cause deranged injury site physiology, metabolism and inflammation and is associated with wound infections.

Conclusions

TSCI is a multi-system disease. Injury site multi-modal monitoring can calculate key parameters such as ISP and SCPP. Injury site physiology and metabolism varies and correlates with motor, bladder and sphincter outcomes. Cooling does not optimise the injury site. Our findings support individualised patient monitoring and management through optimising SCPP and ISP in patients with acute severe TSCI.

Publication Type:	Thesis (Doctoral)
Subjects:	R Medicine > RC Internal medicine R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry R Medicine > RD Surgery
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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