The Effect of Prophylactic Hypothermia on Neurophysiological and Functional Measures in the Setting of Iatrogenic Spinal Cord Impact Injury

• Published in: World neurosurgery Vol. 129; pp. e607 - e613
• Main Authors: Jorge, Ahmed, Fish, Erika J., Dixon, C. Edward, Hamilton, Kojo D., Balzer, Jeffrey, Thirumala, Parthasarathy
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2019
• Subjects: Animals; Behavior, Animal - physiology; Evoked Potentials, Somatosensory - physiology; Female; Hypothermia; Hypothermia, Induced - methods; Models, Animal; Motor Activity - physiology; Rats; Rats, Sprague-Dawley; Somatosensory evoked potentials; Spinal Cord - physiopathology; Spinal Cord Injuries - physiopathology; Spinal Cord Injuries - prevention & control; Spinal cord injury; iSCI; BBB; Somatosensory evoked potentials; SCI; TBI; Spinal cord injury; SSEP; Hypothermia
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2019.05.229

Iatrogenic spinal cord injury (iSCI) during spinal corrective surgery can result in devastating complications, such as paraplegia or paraparesis. Perioperatively, iSCI often occurs as a direct injury during spinal cord instrumentation placement. Currently, treatment of iSCI remains limited to posttraumatic hypothermia, which has demonstrated some value in recent clinical trials. Here we report the outcomes of preinjury hypothermia initiated preprocedurally and maintained for a considerable time after iSCI. Twenty-six female Sprague–Dawley rats were assigned at random to either a normothermic group (36 °C) or a hypothermic group (32 °C) and then underwent a laminectomy procedure at the T8 level. Each group was further divided at random to receive a 200-kdyn force contusive spinal cord injury or a sham impact. Hypothermic rats were then rewarmed after 2 hours of hypothermic treatment. Behavioral scores, temperature profiles, weights, and somatosensory evoked potentials were obtained at baseline and at specified time points after the procedure. The median survival was 42 days for the iSCI hypothermic group and 11 days for the iSCI normothermic group (hazard ratio, 3.82; 95% confidence interval, 1.52–9.57). The probability of survival was significantly higher in the iSCI hypothermic group compared with the iSCI normothermic group (χ2 = 4.18; P = 0.040). The hypothermic group exhibited a higher Basso, Beattie and Bresnahan (BBB) locomotor rating scale score (17 vs. 14; P < 0.01), lower normalized latencies (1.06 ± 0.16 seconds vs. 1.34 ± 0.17 seconds; P = 0.04), and higher peak-to-peak amplitudes (0.32 ± 0.10 μV vs. 0.12 ± 0.09 μV; P = 0.005). The use of prophylactic hypothermia before iSCI was significantly associated with an increased survival rate, higher BBB scores, and improved neurophysiological measures.