Orthopaedic and Injury Biomechanics Laboratory, Departments of Mechanical Engineering and Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.
Spine (Phila Pa 1976). 2012 Jul 1;37(15):E890-9. doi: 10.1097/BRS.0b013e3182553d1d.
Quantitative in vivo ultrasound imaging study of spinal cord and dura morphology after acute experimental spinal cord injury (SCI) and decompression in a pig model.
To study the morphological changes of the spinal cord and dura immediately after surgical decompression for acute SCI.
Surgical decompression for traumatic SCI is currently a topic of debate. After decompression, relief of bony impingement on the thecal sac and spinal cord can be confirmed intraoperatively. However, postoperative imaging often reveals that the cord has swollen to fill the subarachnoid space. Little is known about the extent and timing of this morphological response.
Yucatan miniature pigs received sham surgery (N = 1) or a moderate (N = 6, 20 g, 2.3 m/s) or high (N = 6, 20 g, 4.7 m/s) severity weight-drop SCI followed by 8 hours of sustained compression (100 g) and 6 hours of postdecompression monitoring. Sagittal-plane ultrasound images were used to quantify spinal cord, dura, and subarachnoid space dimensions preinjury and once per hour after decompression.
Animals with a moderate SCI exhibited a residual cord deformation of up to 0.64 mm within 10 minutes of decompression, which tended to resolve during 6 hours because of tissue relaxation and swelling. For animals with high-severity SCIs, cord swelling was immediate and resulted in occlusion of the subarachnoid space within 10 minutes to 5 hours, whereas this occurred for only half of the moderate injury group.
Decompression of an acute SCI may result in residual cord deformation followed by gradual swelling or immediate swelling leading to subarachnoid occlusion. The response is dependent on initial injury severity. These observations may partly explain the lack of benefit of decompression in some patients and suggest a need to reduce cord swelling to optimize the clinical outcome after acute SCI.
在猪模型中进行急性实验性脊髓损伤（SCI）和减压后脊髓和硬脑膜形态的定量活体超声成像研究。
研究急性 SCI 手术后脊髓和硬脑膜形态的即刻变化。
目前，手术减压治疗创伤性 SCI 是一个有争议的话题。减压后，术中可确认硬脊膜囊和脊髓的骨性压迫得到缓解。然而，术后影像学常显示脊髓肿胀至填满蛛网膜下腔。对于这种形态学反应的程度和时间，知之甚少。
尤卡坦微型猪接受假手术（N=1）或中度（N=6，20g，2.3m/s）或高度（N=6，20g，4.7m/s）严重程度的重物坠落 SCI，然后持续受压 8 小时（100g）和 6 小时减压后监测。矢状面超声图像用于在损伤前和减压后每小时测量一次脊髓、硬脑膜和蛛网膜下腔的尺寸。
中度 SCI 动物在减压后 10 分钟内表现出高达 0.64mm 的残余脊髓变形，由于组织松弛和肿胀，这种变形在 6 小时内趋于缓解。对于严重程度较高的 SCI 动物，脊髓肿胀是即刻发生的，导致蛛网膜下腔在 10 分钟至 5 小时内闭塞，而中度损伤组只有一半发生这种情况。
急性 SCI 的减压可能导致残余脊髓变形，随后逐渐肿胀或立即肿胀导致蛛网膜下腔闭塞。这种反应取决于初始损伤的严重程度。这些观察结果可能部分解释了一些患者减压没有益处，并表明需要减少脊髓肿胀以优化急性 SCI 后的临床结果。
