New Surgical Attitude in Complete Acute Traumatic Spinal Cord Injury

Abstract

Introduction Studies have shown the values pattern of the phosphorylated form of the high-molecular-weight neurofilament subunit (pNF-H) in CSF is a predictive biomarker for acute traumatic spinal cord injury (SCI). Materials and Methods A previous study of pNF-H in CSF of patients with SCI showed it is a specific biomarker for SCI, it can distinguish the severity of SCI and it is a predictive biomarker because of its values pattern can show the reducing or stopping of the secondary lesion and a favorable result. At 22 subjects with acute traumatic SCI we correlated the pNF-H concentration in CSF with the MRI, with the diffusion tensor tractography on the SCI site and with the clinical evolution. All patients underwent surgery during the first 24 hours (decompression, stabilization). In two cases with unfavorable pattern of pNF-H after 4 and 7 days, MRI identified the SCI site with an extensive spinal cord edema and a necrotic cavity. A second microneurosurgery was done: opening the dura 5 levels, duraplasty and opening the spinal cord in the midline and debridement of the necrotic tissue. Results Complete SCI cases had a specific pattern of values of pNF-H correlated with the MRI and the clinical evolution. A second microneurosurgery solved the cord edema and the spinal cord laceration. One case has improved progressively after 6 months and the other case - no neurological improvement after one year of rehabilitation. Conclusions Patients must undergo surgery during the first 24 hours: a large decompression on 5 – 7 levels with duraplasty and stabilization. After these we can use the predictive unfavorable pattern of pNF-H correlated with MRI and a second microneurosurgery in SCI site must be done: opening the spinal cord in the midline and microsurgical debridement of the necrotic tissue. This surgical attitude can create favorable conditions for functional recovery of the remaining spinal cord.