Early durotomy with duroplasty for severe adult spinal cord injury without radiographic abnormality: a novel concept and method of surgical decompression

• Published in: European spine journal Vol. 28; no. 10; pp. 2275 - 2282
• Main Authors: Zhu, Fengzhao, Yao, Sheng, Ren, Zhengwei, Telemacque, Dionne, Qu, Yanzhen, Chen, Kaifang, Yang, Fan, Zeng, Lian, Guo, Xiaodong
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2019; Springer Nature B.V
• Subjects: Adult; Aged; Cerebrospinal fluid; Cervical Vertebrae - diagnostic imaging; Compression; Contusions; Decompression; Decompression, Surgical - methods; Dura Mater - surgery; Edema; Female; Hemorrhage; Humans; Laminectomy; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Neurosurgery; Neurosurgical Procedures; NMR; Nuclear magnetic resonance; Original Article; Patients; Pressure; Prognosis; Retrospective Studies; Spinal cord injuries; Spinal Cord Injuries - surgery; Surgical Orthopedics; Young Adult; Adult spinal cord injury without radiographic abnormality; Early decompression surgery; Durotomy and duroplasty; Magnetic resonance imaging; Intraspinal pressure monitoring
• ISSN: 0940-6719; 1432-0932
• DOI: 10.1007/s00586-019-06091-1

Purpose Treatment options for adult spinal cord injury without radiographic abnormality (ASCIWORA) varied. Compression of ASCIWORA may more likely result from spinal cord lesions such as edema and hemorrhage or contusion. This study aimed to explore the clinical effect of early durotomy with duroplasty decompression in the treatment of severe ASCIWORA. Methods Data of 16 patients with ASCIWORA who underwent early ( < 72 h) posterior laminectomy followed by durotomy with duroplasty decompression from June 2015 to January 2017 were retrospectively analyzed. Patients’ prognosis was analyzed by American Spinal Injury Association Impairment Scale (AIS) grades and scores. In 3 patients, intraspinal pressure (ISP) was continuously monitored for 1 week. Results Cervical magnetic resonance imaging (MRI) revealed spinal cord edema in 9 patients and suspected hemorrhage or contusion in 7 cases. Pathological manifestations of spinal cord injury found during the operation were consistent with preoperative MRI findings. Of the 16 cases, AIS grade was improved by 1 grade in 3 cases, 2 grades in 11 cases, and 3 grades in 1 case. The AIS scores at the last follow-up were significantly higher than preoperative scores. There was a high level of ISP after laminectomy, whereas ISP continued to decrease steadily after durotomy. Conclusions Durotomy helps thoroughly decompress the spinal cord and improve cerebrospinal fluid circulation in severe ASCIWORA cases. Cervical MRI and pathological investigation of the spinal cord can be used to evaluate and predict the prognosis of ASCIWORA patients. ISP monitoring is an effective method for evaluating intramedullary pressure and decompression. Graphic abstract These slides can be retrieved under Electronic Supplementary Material.