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European Journal of Orthopaedic Surgery & Traumatology

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01-07-2014 | Original Article

Mitigating spinal cord distraction injuries: the effect of durotomy in decreasing cord interstitial pressure in vitro

Authors: Waleed Awwad, Mahdi Bassi, Ian Shrier, Abdulaziz Al-Ahaideb, Russell J. Steele, Peter F. Jarzem

Published in: European Journal of Orthopaedic Surgery & Traumatology | Special Issue 1/2014

Abstract

Study design

The present study involved an in vitro examination of spinal cord interstitial pressure (CIP) during distraction before and after durotomy in three spinal cord segments obtained from five pigs.

Objectives

To determine whether durotomy can be used to decrease the elevated CIP associated with spinal cord distraction.

Summary of background data

Spinal cord distraction is a known cause of spinal cord injury. Several articles describing the pathophysiology of cord distraction injuries suggest that the underlying mechanism of injury is a microvascular ischemic event. The authors have previously described an increase in CIP with spinal cord distraction, with average pressures of 23 mmHg at loads of 1,000 g. To date, there are no published studies that have evaluated the efficacy of intentional durotomies as a treatment for elevated CIP.

Methods

A total of 15 spinal cord sections were harvested from pigs and distracted while immersed in saline, using a fixed 1,000 g distraction force. The CIP decay was then measured at 30-s intervals for 10 min. The distraction/relaxation maneuver was performed six times with continuous CIP monitoring and was subsequently followed by durotomy.

Results

The pressure–decay curves were similar for each specimen, but varied according to individual pigs and anatomical levels. CIP decayed over the first 4 min of distraction and remained constant for the final 6 min. Longitudinal durotomy led to a dramatic drop in CIP toward baseline and appeared to be as effective as transverse durotomy with regard to the normalization of pressure.

Conclusion

Spinal cord distraction causes elevations in CIP. Durotomy lowers elevated CIP in vitro and may be effective at lowering CIP in vivo. Further study is required to evaluate the usefulness of durotomy in vivo.

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Title: Mitigating spinal cord distraction injuries: the effect of durotomy in decreasing cord interstitial pressure in vitro
Authors: Waleed Awwad
Mahdi Bassi
Ian Shrier
Abdulaziz Al-Ahaideb
Russell J. Steele
Peter F. Jarzem
Publication date: 01-07-2014
Publisher: Springer Paris
Published in: European Journal of Orthopaedic Surgery & Traumatology / Issue Special Issue 1/2014
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-013-1409-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Mitigating spinal cord distraction injuries: the effect of durotomy in decreasing cord interstitial pressure in vitro

Abstract

Study design

Objectives

Summary of background data

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Study design

Objectives

Summary of background data

Methods

Results

Conclusion

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