Our Summary

This research paper focuses on the importance of monitoring pressure within the spinal cord (intraspinal pressure or ISP) immediately after a traumatic spinal cord injury (tSCI). It suggests that better medical and surgical treatment can be provided during this critical period by continuous monitoring and adjusting the blood flow to the spinal cord (spinal cord perfusion pressure or SCPP). The study finds that the best SCPP is between 90 and 100 mm Hg.

The paper also looks at the effectiveness of various surgical treatments. It suggests that laminectomy (a surgery where part of the vertebral bone is removed) on its own is not effective in reducing the ISP because it does not reduce the pressure placed on the swollen spinal cord by the outer layer of the spinal cord (the dura). Instead, the paper suggests that a surgical procedure involving bony decompression with durotomy (opening up the dura) or duroplasty (repairing the dura) is more effective in reducing ISP to less than 20mm Hg.

The paper concludes by stating that further trials are needed to confirm whether performing a laminectomy with durotomy and continuous ISP monitoring can improve the recovery of patients with tSCI.

FAQs

  1. What is the importance of monitoring intraspinal pressure (ISP) after a traumatic spinal cord injury?
  2. Why is laminectomy not effective in reducing intraspinal pressure according to the research paper?
  3. What are the surgical procedures suggested by the paper to be more effective in reducing intraspinal pressure?

Doctor’s Tip

A doctor might tell a patient undergoing a spinal laminectomy that it is important to follow post-operative instructions carefully, including proper wound care, physical therapy, and avoiding activities that could strain the spine. They may also recommend regular follow-up appointments to monitor healing and address any complications early on. Additionally, the doctor may advise the patient to maintain a healthy lifestyle, including proper nutrition and regular exercise, to support the healing process and overall spinal health.

Suitable For

Patients who are typically recommended spinal laminectomy are those with traumatic spinal cord injuries (tSCI) who are experiencing elevated intraspinal pressure (ISP) that is not effectively reduced by laminectomy alone. These patients may benefit from a surgical procedure involving bony decompression with durotomy or duroplasty to reduce ISP to an optimal level (less than 20mm Hg) and improve spinal cord perfusion pressure (SCPP). Further research is needed to determine the effectiveness of this approach in improving the recovery of patients with tSCI.

Timeline

  • Before spinal laminectomy:
  1. Patient experiences symptoms of spinal cord compression, such as pain, weakness, numbness, and difficulty walking.
  2. Patient undergoes diagnostic tests, such as X-rays, MRI, and CT scans, to confirm the diagnosis of spinal stenosis or herniated disc.
  3. Patient may try conservative treatments, such as physical therapy, medication, and injections, to manage symptoms.
  4. If conservative treatments are unsuccessful, patient and surgeon decide to proceed with spinal laminectomy surgery.
  • After spinal laminectomy:
  1. Patient undergoes pre-operative preparation, including medical evaluation and discussion of the procedure with the surgeon.
  2. Patient undergoes spinal laminectomy surgery, during which part of the lamina (the bony arch of the vertebra) is removed to relieve pressure on the spinal cord or nerves.
  3. Patient undergoes post-operative care, including pain management, physical therapy, and monitoring for complications such as infection or nerve damage.
  4. Patient gradually resumes normal activities and experiences improvement in symptoms, such as reduced pain and improved mobility.
  5. Patient may require ongoing rehabilitation and follow-up appointments to monitor recovery and address any lingering symptoms or complications.

What to Ask Your Doctor

  1. What is the purpose of a spinal laminectomy in treating my condition?
  2. Will a spinal laminectomy alone be sufficient in reducing intraspinal pressure or do I need additional procedures like durotomy or duroplasty?
  3. What are the potential risks and complications associated with a spinal laminectomy?
  4. How long is the recovery process after a spinal laminectomy?
  5. Will I need physical therapy or rehabilitation after the surgery?
  6. What is the success rate of a spinal laminectomy in improving symptoms and function?
  7. Are there alternative treatment options to consider?
  8. How will my progress be monitored after the surgery?
  9. What are the expected outcomes in terms of pain relief and mobility improvement?
  10. Are there any long-term effects or considerations I should be aware of after a spinal laminectomy?

Reference

Authors: Tykocki T, Poniatowski Ł, Czyż M, Koziara M, Wynne-Jones G. Journal: World Neurosurg. 2017 Sep;105:145-152. doi: 10.1016/j.wneu.2017.05.138. Epub 2017 Jun 1. PMID: 28578120