Gee Cameron M, Kwon Brian K
Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Canada.
International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Canada.
J Clin Orthop Trauma. 2022 Sep 11;34:102024. doi: 10.1016/j.jcot.2022.102024. eCollection 2022 Nov.
This scoping review systematically reviewed relevant research to summarize the literature addressing the significance of monitoring spinal cord perfusion pressure (SCPP) in acute traumatic spinal cord injury (SCI). The objectives of the review were to (1) examine the nature of research in the field of SCPP monitoring in SCI, (2) summarize the key research findings in the field, and (3) identify research gaps in the existing literature and future research priorities. Primary literature searches were conducted using databases (Medline and Embase) and expanded searches were conducted by reviewing the references of eligible articles and searches of Scopus, Web of Science core collection, Google Scholar, and conference abstracts. Relevant data were extracted from the studies and synthesis of findings was guided by the identification of patterns across studies to identify key themes and research gaps within the literature. Following primary and expanded searches, a total of 883 articles were screened. Seventy-three articles met the review inclusion criteria, including 34 original research articles. Other articles were categorized as conference abstracts, literature reviews, systematic reviews, letters to the editor, perspective articles, and editorials. Key themes relevant to the research question that emerged from the review included the relationship between SCPP and neurological recovery, the safety of monitoring pressures within the intrathecal space, and methods of intervention to enhance SCPP in the setting of acute traumatic SCI. Original research that aims to enhance SCPP by targeting increases in mean arterial pressure or reducing pressure in the intrathecal space is reviewed. Further discussion regarding where pressure within the intrathecal space should be measured is provided. Finally, we highlight research gaps in the literature such as determining the feasibility of invasive monitoring at smaller centers, the need for a better understanding of cerebrospinal fluid physiology following SCI, and novel pharmacological interventions to enhance SCPP in the setting of acute traumatic SCI. Ultimately, despite a growing body of literature on the significance of SCPP monitoring following SCI, there are still a number of important knowledge gaps that will require further investigation.
本综述性研究系统回顾了相关研究，以总结有关监测急性创伤性脊髓损伤（SCI）中脊髓灌注压（SCPP）意义的文献。该综述的目的是：（1）审视SCI中SCPP监测领域的研究性质；（2）总结该领域的关键研究发现；（3）识别现有文献中的研究空白以及未来的研究重点。通过数据库（Medline和Embase）进行了初步文献检索，并通过查阅符合条件文章的参考文献以及检索Scopus、科学引文索引核心合集、谷歌学术和会议摘要进行了扩展检索。从研究中提取了相关数据，并通过识别各研究间的模式来指导结果的综合分析，以确定文献中的关键主题和研究空白。经过初步和扩展检索后，共筛选了883篇文章。73篇文章符合综述纳入标准，其中包括34篇原创研究文章。其他文章分类为会议摘要、文献综述、系统综述、给编辑的信、观点文章和社论。该综述中出现的与研究问题相关的关键主题包括SCPP与神经功能恢复之间的关系、鞘内空间压力监测的安全性以及在急性创伤性SCI情况下提高SCPP的干预方法。对旨在通过提高平均动脉压或降低鞘内空间压力来提高SCPP的原创研究进行了综述。还提供了关于应在何处测量鞘内空间压力的进一步讨论。最后，我们强调了文献中的研究空白，例如确定较小中心进行侵入性监测的可行性、需要更好地了解SCI后脑脊液生理学，以及在急性创伤性SCI情况下提高SCPP的新型药物干预措施。最终，尽管关于SCI后SCPP监测意义的文献越来越多，但仍存在一些重要的知识空白，需要进一步研究。
