Abstract
It is difficult to assess and monitor the spinal cord injury (SCI) because of its pathophysiology after injury, with different degrees of prognosis and various treatment methods, including laminectomy, durotomy, and myelotomy. Medical communication services with different factors such as time of surgical intervention, procedure choice, spinal cord perfusion pressure (SCPP), and intraspinal pressure (ISP) contribute a significant role in improving neurological outcomes. This review aims to show the benefits of communication services and factors such as ISP, SCPP, and surgical intervention time in order to achieve positive long-term outcomes after an appropriate treatment method in SCI patients. The SCPP was found between 90 and 100 mmHg for the best outcome, MAP was found between 110 and 130 mmHg, and mean ISP is ≤20 mmHg after injury. Laminectomy alone cannot reduce the pressure between the dura and swollen cord. Durotomy and duroplasty considered as treatment choices after severe traumatic spinal cord injury (TSCI).
Highlights
Most sufferers of complete SCI are paralyzed, with no bladder, bowel, or sexual function [1]. e swollen spinal cord is compressed by the dura mater, leading to raised intraspinal pressure (ISP). e worse the cord perfusion, the worse the prognosis [2, 3]
If SCPP is less than 60 mmHg, it can cause further ischemia, so improving the mean arterial pressure (MAP) and keeping the ISP at ≤20 mmHg level can improve the blood flow and avoid ischemia at the injury site
Data show that the SCPP after the injury was 90–100 mmHg and >60mmHg to avoid ischemia, MAP of 110–130 mmHg, and the mean ISP after an injury is ≤20 mmHg
Summary
Most sufferers of complete SCI are paralyzed, with no bladder, bowel, or sexual function [1]. e swollen spinal cord is compressed by the dura mater, leading to raised intraspinal pressure (ISP). e worse the cord perfusion, the worse the prognosis [2, 3]. E swollen spinal cord is compressed by the dura mater, leading to raised intraspinal pressure (ISP). E worse the cord perfusion, the worse the prognosis [2, 3]. Current research has shown that the optimal spinal perfusion pressure (SCPPopt) varies from person to person [4], and no factor accurately predicts SCPPopt. E treatment method can be adjusted to improve blood perfusion and prognosis and to prevent secondary injury [6, 7]. An appropriate treatment method is necessary to reduce ISP and achieve significant outcomes. Performing bony decompression is not enough to decrease the pressure around the cord. E response depends on the initial severity of the injury; these points need a treatment that is effective in reducing swelling to optimize the clinical outcome [9]. Even if bony decompression is performed early, gradual or immediate swelling can cause subarachnoid occlusion [8]. e response depends on the initial severity of the injury; these points need a treatment that is effective in reducing swelling to optimize the clinical outcome [9]. is review aims to present different factors that affect the prognosis in SCI patients and compare the effect of myelotomy and durotomy procedures in humans and animals with SCI
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