Case report: Continuous spinal cord physiologic monitoring following traumatic spinal cord injury—A report from the Winnipeg Intraspinal Pressure Study (WISP)

Frontiers in Neurology, 2023 · DOI: 10.3389/fneur.2023.1069623 · Published: April 11, 2023

Simple Explanation

This case report describes the first North American attempt to measure pressure within the spinal cord after a traumatic injury using a special monitoring device. The device was placed during surgery to relieve pressure on the spinal cord. The monitoring device allowed doctors to track spinal cord perfusion pressure, which is important for preventing further damage after an injury. The procedure was performed without complications, and the patient showed some improvement during rehabilitation. The study suggests that this type of monitoring is feasible and safe, but more research is needed to confirm its benefits and determine how best to use it to improve patient outcomes after spinal cord injury.

Study Duration

5 days of physiological monitoring

Participants

Single patient with acute traumatic spinal cord injury (ASIA A)

Evidence Level

Level 4: Case Report

Key Findings

1
Intraspinal pressure can be measured safely and effectively at the site of injury using a subdural strain gauge pressure monitor.
2
Spinal cord perfusion pressure can be derived from intraspinal pressure measurements, providing valuable physiological data.
3
The technique of continuous intraspinal pressure monitoring can be performed without complications in patients with acute traumatic spinal cord injury.

Research Summary

This case report details the successful implementation of continuous intraspinal pressure monitoring using a strain gauge pressure monitor in a patient with acute traumatic spinal cord injury. The procedure, performed during surgical decompression and stabilization, allowed for the measurement of intraspinal pressure and derivation of spinal cord perfusion pressure. The monitoring was conducted for five days post-surgery without complications. The patient demonstrated some neurological improvement during a 3-month rehabilitation period. This suggests the feasibility and safety of the technique. The authors emphasize the need for further research to validate this technique and explore its potential to optimize the management of spinal cord injury by guiding blood pressure manipulation and correlating with markers of neuronal injury.

Practical Implications

Improved Monitoring

Continuous intraspinal pressure monitoring can provide clinicians with real-time data on spinal cord perfusion pressure, allowing for more informed decisions regarding blood pressure management and other interventions.

Personalized Treatment

By understanding the relationship between intraspinal pressure, mean arterial pressure, and spinal cord autoregulation, clinicians can tailor treatment strategies to optimize spinal cord perfusion for individual patients.

Future Research

The successful implementation of this technique opens avenues for further research into spinal cord physiology and the development of targeted therapies for spinal cord injury.

Study Limitations

1
Single case report limits generalizability.
2
Unclear where the catheter should be positioned in relation to the site of injury.
3
Possibility of cerebrospinal fluid leakage around the insertion of the wire.

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