Abstracts of the 2014 Annual Meeting of the AANS/CNS Section on Disorders of the Spine and Peripheral Nerves Orlando, Florida ? March 5–8, 2014

摘要

Introduction Elevation of mean arterial blood pressure (MAP) and cerebrospinal fluid drainage (CSFD) has been used as treatment modalities in patients after acute spinal cord injury (SCI). Currently there is no evidence in support of the routine use of either modality. We sought to determine efficacy of aggressive MAP augmentation combined with lowering of intrathecal pressure (IP) by CSFD to improve spinal cord blood flow (SCBF) after SCI. Methods We induced mild spinal cord injury at the T5 level in pigs. The animals were divided evenly between five groups: Control (laminectomy) (n=3); SCI only (n=3); SCI with elevated MAP (SCI+MAP) (n=3); SCI with CSFD (SCI+CSFD) (n=3); SCI with CSFD and elevated MAP (SCI+MAP+CSFD) (n=3). Elevated MAP and CSFD was initiated 1 hour after SCI. CSF diversion was achieved via lumbar drain. Elevated MAP was achieved by continuous injection of Phenylephrine. Parameters before SCI, at 1h, 2h, 3h and 4h after SCI were analyzed. All animals underwent continuous monitoring and recording of IP, SCBF at SCI level and MAP. Results The SCBF in SCI group was decreased by 56% after SCI in comparison with baseline. Increase in blood pressure after SCI resulted in a 34% decrease in SCBF, whereas CSFD resulted in a 59% decrease in SCBF. The combination of CSFD and induced hypertension resulted in a 24% increase in SCBF. The SCI group had stable IP throughout experiment. The SCI+MAP group had an average of 5.45 mmHg IP increase after MAP increase 1 hour after SCI. Conclusions SCI does not result in increase in IP. Increased MAP in the setting of SCI causes increase in IP, which results in decreased spinal cord perfusion pressure (SCPP) (SCPP=MAP-IP). Both elevated MAP and CSFD showed only short-term improvement of SCBF followed by hypoperfusion when implemented independently. The combination of increased MAP and CSFD improves SCBF after SCI.