Greil Madeline E, Hunt Emily R, Torres Espin Abel, Saigal Rajiv
Department of Neurological Surgery, University of Washington, Seattle, WA, USA.
Department of Orthopaedic Surgery, University of Washington, Seattle, WA, USA.
Global Spine J. 2025 Sep 4:21925682251376321. doi: 10.1177/21925682251376321.
Study DesignRetrospective single-center review.ObjectivesAssess whether expansile duraplasty was associated with greater motor recovery in patients with acute traumatic spinal cord injury (tSCI) compared with bony decompression alone.MethodsRetrospective chart review was conducted for patients who underwent surgical stabilization and decompression for tSCI at a level-1 trauma center. Changes in motor scores were calculated and compared between patients who had expansile duraplasty and those who did not.ResultsWe studied 96 patients: 11 who underwent expansile duraplasty and 85 who did not. The average pre-operative motor scores for patients with duraplasty was 33.3 ± 22.5 compared to 49.0 ± 29.3 for non-duraplasty ( = 0.11). At hospital discharge the duraplasty group had an average motor score of 43.1 ± 26.3 with an average score of 52.9 ± 29.4 for the non-duraplasty group ( = 0.41). The average motor score at the time of inpatient rehabilitation discharge was 55.3 ± 28.6 for duraplasty and 60.1 ± 30.3 for non-duraplasty ( = 0.37). The change in motor score between baseline and hospital discharge was 9.8 ± 11.8 for duraplasty and 3.9 ± 11.4 for controls ( = 0.088). There was a higher change in motor score from baseline to inpatient rehabilitation discharge in the duraplasty group (20.3 ± 11.6 vs 11.1 ± 13.5 for controls, = 0.034) even after adjusting for covariates through inverse probability weighting ( = 0.017). The duraplasty group did not have significantly more complications.ConclusionsPatients who underwent expansile duraplasty at the time of surgical stabilization and decompression for acute tSCI had greater motor improvement between preoperative evaluation and rehabilitation discharge than patients without duraplasty. This technique warrants further study in a multi-center, prospective study.
研究设计
回顾性单中心研究。
目的
评估与单纯行骨减压术相比，扩张性硬脑膜成形术是否能使急性创伤性脊髓损伤（tSCI）患者获得更好的运动功能恢复。
方法
对在一级创伤中心接受tSCI手术固定及减压治疗的患者进行回顾性病历审查。计算并比较接受扩张性硬脑膜成形术患者与未接受该手术患者的运动评分变化。
结果
我们研究了96例患者：11例行扩张性硬脑膜成形术，85例未行该手术。行硬脑膜成形术患者的术前平均运动评分为33.3±22.5，未行该手术患者为49.0±29.3（P = 0.11）。出院时，硬脑膜成形术组的平均运动评分为43.1±26.3，未行该手术组为52.9±29.4（P = 0.41）。住院康复出院时，硬脑膜成形术组的平均运动评分为55.3±28.6，未行该手术组为60.1±30.3（P = 0.37）。硬脑膜成形术组从基线到出院时运动评分的变化为9.8±11.8，对照组为3.9±11.4（P = 0.088）。即使通过逆概率加权法调整协变量后，硬脑膜成形术组从基线到住院康复出院时运动评分的变化仍更高（20.3±11.6对比对照组的11.1±13.5，P = 0.034）（P = 0.017）。硬脑膜成形术组的并发症并未显著增多。
结论
在急性tSCI手术固定及减压时接受扩张性硬脑膜成形术的患者，与未行该手术的患者相比，在术前评估至康复出院期间运动功能改善更大。该技术值得在多中心前瞻性研究中进一步探究。
