Intracanal Pressure in Compressive Spinal Cord Injury: Reduction with Hypothermia
Intracanal Pressure in Compressive Spinal Cord Injury: Reduction with Hypothermia
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DOI：
10.1089/neu.2010.1622
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发表时间：
2011-05-01
影响因子：
4.2
通讯作者：
Howells, David W.
中科院分区：
文献类型：
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作者：
Batchelor, Peter E.;Kerr, Nicole F.;Howells, David W.
大多数人脊髓损伤(SCI)病例都伴有持续的脊髓压迫。在实验上，压迫会导致神经功能在数小时内迅速下降，这表明损伤部位的局部管内压力上升。本研究的目的是测量进行性闭塞时局部管内压力的升高，并确定管内压力升高与神经学结果之间的关系。我们还旨在确定低温是否能够降低升高的根管内压。我们证明，在F344大鼠脊髓损伤后，局部根管内压力保持在接近正常的水平，直到椎管闭塞超过直径的30%，随后压力迅速增加。椎管内压力似乎是神经功能恢复的一个重要决定因素，在45%的椎管闭塞8h后，动物的长期行为和组织学结果很差，其中椎管内压力显著升高。相比之下，神经功能恢复良好的动物接近正常的椎管内压(30%椎管堵塞8小时或立即减压的动物)。我们进一步证明，低温是一种有效的治疗方法，可以控制升高的根管内压，迅速将伴有严重(45%)椎管闭塞的升高的根管内压降至接近正常。总体而言，这些数据表明，脊髓损伤后，在局部椎管内压力迅速上升，导致神经预后急剧下降之前，只有有限的椎管狭窄是可以容忍的。升高的椎管内压可以通过低温控制，这可能是手术减压前紧急减压的一种有用的治疗方法。
Most cases of human spinal cord injury (SCI) are accompanied by continuing cord compression. Experimentally, compression results in rapid neurological decline over hours, suggesting a rise in intracanal pressure local to the site of injury. The aim of this study was to measure the rise in local intracanal pressure accompanying progressive canal occlusion and to determine the relationship between raised intracanal pressure and neurological outcome. We also aimed to establish whether hypothermia was able to reduce raised intracanal pressure. We demonstrate that, following SCI in F344 rats, local intracanal pressure remains near normal until canal occlusion exceeds 30% of diameter, whereupon a rapid increase in pressure occurs. Intracanal pressure appears to be an important determinant of neurological recovery, with poor long-term behavioural and histological outcomes in animals subject to 8 h of 45% canal occlusion, in which intracanal pressure is significantly elevated. In contrast, good neurological recovery occurs in animals with near normal intracanal pressure (animals undergoing 8 h of 30% canal occlusion or those undergoing immediate decompression). We further demonstrate that hypothermia is an effective therapy to control raised intracanal pressure, rapidly reducing elevated intracanal pressure accompanying critical (45%) canal occlusion to near normal. Overall these data indicate that following SCI only limited canal narrowing is tolerated before local intracanal pressure rapidly rises, inducing a sharp decline in neurological outcome. Raised intracanal pressure can be controlled with hypothermia, which may be a useful therapy to emergently decompress the spinal cord prior to surgical decompression.