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Early Surgical Decompression With Duraplasty in Acute Spinal Cord Injury Improves Functional Recovery in an Animal Model: Paper #62

Smith, Jeremy S. MD; Anderson, Ryan; Pham, Thu; Bhatia, Nitin MD (University of California‐ Irvine); Steward, Oswald PhD; Gupta, Ranjan MD

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Spine Journal Meeting Abstracts: September 2009 - Volume 10 - Issue - p 97
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Introduction: The role of decompressing the subarachnoid space through a durotomy as a treatment option for acute traumatic spinal cord injury (SCI) in the cervical spinal cord has not been explored. We sought to determine the role of durotomy and duraplasty in acute cervical SCI and its effects on inflammation, scar formation and functional recovery.

Methods: Seventy‐two adult female Sprague‐Dawley rats were assigned to 3 groups: contusion injury alone, contusion injury with durotomy and decompression, and contusion injury with durotomy followed by placement of a dural allograft. A moderate contusive injury was delivered to the exposed spinal cord at C5 using a force directed impactor. The injured segment was re‐exposed 4 hours after injury and a durotomy with decompression was performed. Dural allografts were affixed to the surrounding intact dura using a fibrin sealant. The Grip Strength Meter (GSM) was used to assess forelimb function. Animals were sacrificed at 2 and 4 weeks and immunohistochemistry was performed to assess scar formation, inflammatory cell infiltration, and lesional volume.

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Results: Animals receiving dural allograft had significantly improved GSM scores in the recovery period relative to other groups. (p<0.05). Immunohistochemical analysis revealed increased scar formation, cavitation and inflammatory response in the animals treated only with a decompressive durotomy. Relative to the group receiving a contusion injury alone, animals receiving a durotomy followed by dural allograft displayed decreased cavitation and scar formation. Lesional volume measurements showed significantly increased (p<0.05) cavitation size at 4 weeks in both the contusion only and durtomy only groups relative to those animals that received dural allograft following durotomy.

Conclusion: Functional recovery after acute cervical SCI was improved with decompression of the subarachnoid space and placement of a dural allograft. This behavior data correlated with the histologic evidence of decreased spinal cord cavitation and scar formation. The results support the rationale of acutely decompressing the subarachnoid space following a compressive spinal cord injury.

© 2009 Lippincott Williams & Wilkins, Inc.