194. Expansile duraplasty improves motor outcomes after acute traumatic spinal cord injury

Abstract

<h3>BACKGROUND CONTEXT</h3> Traumatic spinal cord injury (SCI) can lead to debilitating motor weakness with long term impacts on quality of life. Following the initial trauma, secondary injury mechanisms, including edema, ischemia and inflammation can lead to considerable extension of the injury, providing a window of opportunity for interventions to preserve function. Early surgical decompression and optimization of spinal cord perfusion have emerged as potential targets. Expansile duraplasty could provide benefit by extending surgical decompression to the intrathecal space and increasing spinal cord perfusion; however, there remains a paucity of data on whether this provides a measurable benefit. <h3>PURPOSE</h3> Assess whether expansile duraplasty is associated with greater motor recovery in patients with acute traumatic SCI compared with bony decompression alone. <h3>STUDY DESIGN/SETTING</h3> Retrospective review of medical records. <h3>PATIENT SAMPLE</h3> Patients who underwent surgical spinal decompression and stabilization for traumatic spinal cord injury from February 2017 to June 2021 at an academic, Level 1 trauma center. Patients were excluded from analysis if they did not attend inpatient rehabilitation after their acute hospital stay. <h3>OUTCOME MEASURES</h3> Change in American Spinal Injury Association (ASIA) motor scores between preoperative evaluation, acute hospital discharge, and discharge from inpatient rehabilitation. <h3>METHODS</h3> Patients were divided between those who had expansile duraplasty performed at the time of surgical stabilizationand those who did not. Data collected included patient demographics, injury type, surgery performed, and ASIA motor scores (International Standards for Neurological Classification of SCI, range 0-100) preoperatively and at the time of hospital and inpatient rehabilitation discharge. <h3>RESULTS</h3> A total of 101 patients were included: 12 treated with expansile duraplasty and 89 treated without duraplasty. Patients were 76% male with a mean age of 50.9 years. The mean preoperative motor score for all patients was 48.7+/-29.3 (mean +/- std.dev.), 50.5+/-19.7 for the control group and 35.7+/-23.0 for the expansile duraplasty group (p=0.06). From preoperative exam to hospital discharge, the mean improvement in motor score for the control group was 3.7+/-11.3, compared to 9.3+/-11.4 in the expansile duraplasty group (p=0.12). Mean change in motor score from preoperative exam to rehabilitation discharge was 10.9+/-13.4 for controls and 19.9+/-11.0 for expansile duraplasty patients (p=0.02). <h3>CONCLUSIONS</h3> In this contemporaneous, single-center, retrospective study, SCI patients undergoing expansile duraplasty had significantly greater improvement in ASIA motor scores at rehabilitation discharge compared to non-duraplasty controls. These data present an independent and the first US validation of preliminary data from international centers in favor of expansile duraplasty. Further prospective studies are warranted to assess whether this adjunctive surgical technique is efficacious in treating acute traumatic SCI. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.