Chaohua Yang, Tao He, Jingjin Ma, Qing Wang, Song Wang, Gaoju Wang, Jin Yang, Zhiyu Chen, Qiaochu Li, Fangbiao Zhan, Changchun Jian, Daxiong Feng, Zhengxue Quan
{"title":"Duraplasty promotes functional recovery by alleviating intraspinal pressure and edema following severe spinal cord compression injury in rabbits: Experimental studies.","authors":"Chaohua Yang, Tao He, Jingjin Ma, Qing Wang, Song Wang, Gaoju Wang, Jin Yang, Zhiyu Chen, Qiaochu Li, Fangbiao Zhan, Changchun Jian, Daxiong Feng, Zhengxue Quan","doi":"10.1016/j.spinee.2024.12.007","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>After acute traumatic spinal cord injury (tSCI), various surgical strategies have been developed to alleviate elevated intraspinal pressure (ISP) and secondary injury.</p><p><strong>Purpose: </strong>Our study aimed to investigate the impacts of duraplasty and laminectomy on edema progression, perfusion and functional outcomes after severe balloon compression SCI.</p><p><strong>Study design: </strong>In vivo animal study.</p><p><strong>Methods: </strong>Closed balloon compression injuries were induced at the T7 level in rabbits using an inflated volume of 50 μl. Laminectomy (1-level laminectomy: 1-laminectomy; 3-level laminectomy: 3-laminectomy) and duraplasty were performed immediately after model generation. ISP was monitored using a SOPHYSA probe at the epicenter within 7 days post-SCI. Edema progression, perfusion and damage severity were evaluated by serial multisequence MRI scans, behavioral and bladder scores within 8 weeks post-SCI. Blood-spinal cord barrier (BSCB) permeability and histopathology were subsequently analyzed.</p><p><strong>Results: </strong>After SCI, ISP was steeply elevated in the control and 1-laminectomy groups, peaking at 33.14±4.91 and 31.71±4.50 mmHg at 48 h post-SCI; whereas in the 3-laminectomy and duraplasty groups, ISP peaked at 29.43±4.04 and 12.14±1.86 mmHg (p<0.0001) at 72 h post-SCI. MRI and function scores showed that duraplasty significantly reduced the intramedullary lesion length (IMLL) and blood flow reduction ratio, and promoted fiber tract sparing and spinal cord functional recovery (p<0.01). Histopathology revealed that duraplasty significantly reduced BSCB permeability, tissue loss and inflammation and promoted axon preservation (p<0.01), while it did not increase early scar formation.</p><p><strong>Conclusions: </strong>Duraplasty may alleviate secondary SCI and promote functional recovery. This neuroprotective mechanism may be related to reduced ISP and increased perfusion, resulting in reduced edema, BSCB permeability and inflammation and increased nerve fiber tract preservation.</p><p><strong>Clinical significance: </strong>Duraplasty may promote functional recovery following severe tSCI patients, but further investigations are needed.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9000,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Spine Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.spinee.2024.12.007","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Duraplasty promotes functional recovery by alleviating intraspinal pressure and edema following severe spinal cord compression injury in rabbits: Experimental studies.
Background: After acute traumatic spinal cord injury (tSCI), various surgical strategies have been developed to alleviate elevated intraspinal pressure (ISP) and secondary injury.
Purpose: Our study aimed to investigate the impacts of duraplasty and laminectomy on edema progression, perfusion and functional outcomes after severe balloon compression SCI.
Study design: In vivo animal study.
Methods: Closed balloon compression injuries were induced at the T7 level in rabbits using an inflated volume of 50 μl. Laminectomy (1-level laminectomy: 1-laminectomy; 3-level laminectomy: 3-laminectomy) and duraplasty were performed immediately after model generation. ISP was monitored using a SOPHYSA probe at the epicenter within 7 days post-SCI. Edema progression, perfusion and damage severity were evaluated by serial multisequence MRI scans, behavioral and bladder scores within 8 weeks post-SCI. Blood-spinal cord barrier (BSCB) permeability and histopathology were subsequently analyzed.
Results: After SCI, ISP was steeply elevated in the control and 1-laminectomy groups, peaking at 33.14±4.91 and 31.71±4.50 mmHg at 48 h post-SCI; whereas in the 3-laminectomy and duraplasty groups, ISP peaked at 29.43±4.04 and 12.14±1.86 mmHg (p<0.0001) at 72 h post-SCI. MRI and function scores showed that duraplasty significantly reduced the intramedullary lesion length (IMLL) and blood flow reduction ratio, and promoted fiber tract sparing and spinal cord functional recovery (p<0.01). Histopathology revealed that duraplasty significantly reduced BSCB permeability, tissue loss and inflammation and promoted axon preservation (p<0.01), while it did not increase early scar formation.
Conclusions: Duraplasty may alleviate secondary SCI and promote functional recovery. This neuroprotective mechanism may be related to reduced ISP and increased perfusion, resulting in reduced edema, BSCB permeability and inflammation and increased nerve fiber tract preservation.
Clinical significance: Duraplasty may promote functional recovery following severe tSCI patients, but further investigations are needed.
期刊介绍：
The Spine Journal, the official journal of the North American Spine Society, is an international and multidisciplinary journal that publishes original, peer-reviewed articles on research and treatment related to the spine and spine care, including basic science and clinical investigations. It is a condition of publication that manuscripts submitted to The Spine Journal have not been published, and will not be simultaneously submitted or published elsewhere. The Spine Journal also publishes major reviews of specific topics by acknowledged authorities, technical notes, teaching editorials, and other special features, Letters to the Editor-in-Chief are encouraged.
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