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European Spine Journal

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01-01-2017 | Grand Rounds

Increased intrathecal pressure after traumatic spinal cord injury: an illustrative case presentation and a review of the literature

Authors: Lukas Grassner, Peter A. Winkler, Martin Strowitzki, Volker Bühren, Doris Maier, Michael Bierschneider

Published in: European Spine Journal | Issue 1/2017

Abstract

Purpose

Early surgical management after traumatic spinal cord injury (SCI) is nowadays recommended. Since posttraumatic ischemia is an important sequel after SCI, maintenance of an adequate mean arterial pressure (MAP) within the first week remains crucial in order to warrant sufficient spinal cord perfusion. However, the contribution of raised intraparenchymal and consecutively increased intrathecal pressure has not been implemented in treatment strategies.

Methods

Case report and review of the literature.

Results

Here we report a case of a 54-year old man who experienced a thoracic spinal cord injury after a fall. CT-examination revealed complex fractures of the thoracic spine. The patient underwent prompt surgical intervention. Intraoperatively, fractured parts of the ascending Th5 facet joint were displaced into the spinal cord itself. Upon removal, excessive protruding of medullary tissue was observed over several minutes. This demonstrates the clinical relevance of increased intrathecal pressure in some patients.

Conclusion

Monitoring and counteracting raised intrathecal pressure should guide clinical decision-making in the future in order to ensure optimal spinal cord perfusion pressure for every affected individual.

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Title: Increased intrathecal pressure after traumatic spinal cord injury: an illustrative case presentation and a review of the literature
Authors: Lukas Grassner
Peter A. Winkler
Martin Strowitzki
Volker Bühren
Doris Maier
Michael Bierschneider
Publication date: 01-01-2017
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 1/2017
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-016-4769-9

At a glance: The STEP trials

Springer Medicine

Increased intrathecal pressure after traumatic spinal cord injury: an illustrative case presentation and a review of the literature

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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