Streijger Femke, Allard Brown Aysha, Grassner Lukas, Kim Kyoung-Tae, Rizzuto Michael, So Kitty, Manouchehri Neda, Webster Megan, Fisk Shera, Sekhon Mypinder, Griesdale Donald, Kwon Brian
International Collaboration on Repair Discoveries (ICORD), University of British Columbia (UBC), Vancouver, Canada.
Department of Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University Salzburg, Salzburg, Austria.
J Neurotrauma. 2025 Feb;42(3-4):165-181. doi: 10.1089/neu.2024.0308. Epub 2025 Jan 6.
Recent studies have reported that monitoring spinal cord perfusion pressure (SCPP) using a pressure probe to measure "intraspinal pressure" (ISP) within the subdural space at the injury site may improve the hemodynamic management of acute spinal cord injury (SCI) patients. This study aimed to investigate, within a pig model of SCI, the relationship between the ISP measured within the subdural space and the "spinal cord pressure" (SCP) measured within the spinal cord itself. Specifically, we sought to characterize the changes to ISP and SCP over time, both rostral and caudal to the injury epicenter, and in relation to native spinal cord morphometry. Female Yucatan mini-pigs were subjected to a T10 contusion-compression injury. Pressure probes were inserted inside the spinal cord parenchyma for SCP and within the subdural space for ISP, 5-mm rostral, and caudal from the injury site. SCP and ISP were then measured over an 8-hour period post-SCI. Ultrasound images were taken before and after SCI to monitor changes in spinal cord morphometry in the early hours post-injury. Spinal cord swelling was observed in all cases; however, only half of the animals exhibited increased SCP and ISP rostrally. In these, a gradient across the injury site was observed in the ISP measured rostrally and caudally when swelling of the spinal cord filled the subdural space, and the cord was seen to be abutting against the dura. The remaining animals showed a negligible increase in ISP and SCP (<+1 mmHg). The variation in pressure response was influenced heavily by the size of the subdural space surrounding the cord. In cases where we could establish an "optimal SCPP" based on the autoregulatory function of the spinal cord, a discernible variance of approximately 10 mmHg was detected between the values derived from ISP versus SCP. These results suggest that changes in ISP and SCP after SCI are influenced by native spinal cord morphometry and that the location of measurement is important to consider, particularly in situations where the swelling of the injured cord results in an occlusion of the cerebrospinal fluid (CSF) flow through the subdural space.
最近的研究报告称，使用压力探头监测损伤部位硬膜下间隙内的“脊髓内压力”（ISP）以测量脊髓灌注压（SCPP），可能会改善急性脊髓损伤（SCI）患者的血流动力学管理。本研究旨在探讨在SCI猪模型中，硬膜下间隙内测量的ISP与脊髓本身测量的“脊髓压力”（SCP）之间的关系。具体而言，我们试图描述损伤中心头侧和尾侧的ISP和SCP随时间的变化，以及与天然脊髓形态测量学的关系。雌性尤卡坦小型猪遭受T10挫伤-压缩性损伤。将压力探头插入脊髓实质内测量SCP，并插入损伤部位头侧和尾侧5毫米处的硬膜下间隙内测量ISP。然后在SCI后8小时内测量SCP和ISP。在SCI前后拍摄超声图像，以监测损伤后早期脊髓形态测量的变化。在所有病例中均观察到脊髓肿胀；然而，只有一半的动物头侧的SCP和ISP升高。在这些动物中，当脊髓肿胀充满硬膜下间隙且脊髓紧贴硬脑膜时，在头侧和尾侧测量的ISP中观察到损伤部位的梯度。其余动物的ISP和SCP升高可忽略不计（<+1 mmHg）。压力反应的变化在很大程度上受脊髓周围硬膜下间隙大小的影响。在我们能够根据脊髓的自动调节功能建立“最佳SCPP”的情况下，从ISP与SCP得出的值之间检测到约10 mmHg的明显差异。这些结果表明，SCI后ISP和SCP的变化受天然脊髓形态测量学的影响，测量位置很重要，特别是在受伤脊髓肿胀导致脑脊液（CSF）流经硬膜下间隙受阻的情况下。
