Department of Neurological Surgery, The University of Washington, Seattle, Washington, USA.
J Neurotrauma. 2021 Mar 15;38(6):746-755. doi: 10.1089/neu.2020.7297. Epub 2020 Dec 18.
Various surgical strategies have been developed to alleviate elevated intraspinal pressure (ISP) following acute traumatic spinal cord injury (tSCI). Surgical decompression of either the dural (durotomy) or the dural and pial (myelotomy) lining of the spinal cord has been proposed. However, a direct comparison of these two strategies is lacking. Here, we compare the histological and functional effects of durotomy alone and durotomy plus myelotomy in a rodent model of acute thoracic tSCI. Our results indicate that tSCI causes local tissue edema and significantly elevates ISP (7.4 ± 0.3 mmHg) compared with physiological ISP (1.7 ± 0.4 mmHg; < 0.001). Both durotomy alone and durotomy plus myelotomy effectively mitigate elevated local ISP ( < 0.001). Histological examination at 10 weeks after tSCI revealed that durotomy plus myelotomy promoted spinal tissue sparing by 13.7% compared with durotomy alone, and by 25.9% compared with tSCI-only ( < 0.0001). Both types of decompression surgeries elicited a significant beneficial impact on gray matter sparing ( < 0.01). Impressively, durotomy plus myelotomy surgery increased preservation of motor neurons by 174.3% compared with tSCI-only ( < 0.05). Durotomy plus myelotomy surgery also significantly promoted recovery of hindlimb locomotor function in an open-field test ( < 0.001). Interestingly, only durotomy alone resulted in favorable recovery of bladder and Ladder Walk performance. Combined, our data suggest that durotomy plus myelotomy following acute tSCI facilitates tissue sparing and recovery of locomotor function. In the future, biomarkers identifying spinal cord injuries that can benefit from either durotomy alone or durotomy plus myelotomy need to be developed.
各种外科策略已经被开发出来以减轻急性创伤性脊髓损伤（tSCI）后的颅内压升高（ISP）。已经提出了对脊髓的硬脑膜（硬脑膜切开术）或硬脑膜和软脑膜（脊髓切开术）衬里进行减压。然而，缺乏这两种策略的直接比较。在这里，我们在急性胸段 tSCI 的啮齿动物模型中比较了单纯硬脑膜切开术和硬脑膜切开术加脊髓切开术的组织学和功能影响。我们的结果表明，tSCI 导致局部组织水肿，并使 ISP 显著升高（7.4±0.3mmHg），与生理 ISP（1.7±0.4mmHg）相比（ < 0.001）。单独的硬脑膜切开术和硬脑膜切开术加脊髓切开术均能有效减轻局部 ISP 升高（ < 0.001）。tSCI 后 10 周的组织学检查显示，与单独的硬脑膜切开术相比，硬脑膜切开术加脊髓切开术促进了 13.7%的脊髓组织保留，与 tSCI 相比，促进了 25.9%的保留（ < 0.0001）。这两种减压手术都对灰质保留产生了显著的有益影响（ < 0.01）。令人印象深刻的是，与 tSCI 相比，硬脑膜切开术加脊髓切开术使运动神经元的保留增加了 174.3%（ < 0.05）。硬脑膜切开术加脊髓切开术还显著促进了后肢运动功能在旷场测试中的恢复（ < 0.001）。有趣的是，只有单纯的硬脑膜切开术导致了膀胱和 Ladder Walk 性能的良好恢复。总之，我们的数据表明，急性 tSCI 后硬脑膜切开术加脊髓切开术有利于组织保留和运动功能的恢复。在未来，需要开发出能够识别出从单纯硬脑膜切开术或硬脑膜切开术加脊髓切开术中获益的脊髓损伤的生物标志物。
