Skip to main content

Hemodynamic Management of Acute Spinal Cord Injury

  • Conference paper
Intensive Care Medicine
  • 2162 Accesses

Abstract

Acute traumatic spinal cord injury primarily afflicts young people and significantly reduces independence, bestows life-long disability, and consumes huge societal resources. The estimated incidence of acute traumatic spinal cord injury in North America varies from 27–81 cases per million inhabitants per year [1]. The prevalences of spinal cord injury were estimated to be 280 and 681 individuals per million inhabitants in Finland and Australia, respectively. Despite recent efforts at prevention, including laws mandating seat belt use, the incidence of spinal cord injury has not changed significantly and may actually be increasing in certain parts of the population [2, 3]. In addition, the estimated (2006) treatment cost of spinal cord injury is $9.7 billion per year [1]. A number of pharmacological agents (methylprednisolone sodium succinate, and the related compound, tirilazad mesylate; GM-I ganglioside; thyrotropin-releasing hormone; gacyclidine; naloxone; and nimodipine) have been investigated in large, prospective, randomized, controlled clinical trials, but all have failed to demonstrate convincing neurological benefit. Spinal cord injury is frequently associated with systemic hypotension attributable to hypovolemia, direct spinal cord trauma, or both [4].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Similar content being viewed by others

References

  1. Wyndaele M, Wyndaele JJ (2006) Incidence, prevalence and epidemiology of spinal cord injury: what learns a worldwide literature survey? Spinal Cord 44: 523–529

    Article  CAS  PubMed  Google Scholar 

  2. Krause JS (2000) Aging after spinal cord injury: An exploratory study. Spinal Cord 38: 77–83

    Article  CAS  PubMed  Google Scholar 

  3. Marshall LF (2000) Epidemiology and cost of central nervous system injury. Clin Neurosurg 46: 105–112

    CAS  PubMed  Google Scholar 

  4. Congress of Neurological Surgeons (2002) Blood pressure management after acute spinal cord injury. Neurosurgery 50: S58–62

    Article  Google Scholar 

  5. Furlan JC, Fehlings MG (2008) Cardiovascular complications after acute spinal cord injury: pathophysiology, diagnosis, and management. Neurosurg Focus 25: E13

    Article  Google Scholar 

  6. Furlan JC, Fehlings MG, Shannon P, Norenberg MD, Krassioukov AV (2003) Descending vasomotor pathways in humans: correlation between axonal preservation and cardiovascular dysfunction after spinal cord injury. J Neurotrauma 20: 1351–1363

    Article  PubMed  Google Scholar 

  7. Bilello JF, Davis JW, Cunningham MA, Groom TF, Lemaster D, Sue LP (2003) Cervical spinal cord injury and the need for cardiovascular intervention. Arch Surg 138: 1127–1129

    Article  PubMed  Google Scholar 

  8. Guly HR, Bouamra O, Lecky FE (2008) The incidence of neurogenic shock in patients with isolated spinal cord injury in the emergency department. Resuscitation 76: 57–62

    Article  CAS  PubMed  Google Scholar 

  9. Tuli S, Tuli J, Coleman WP, Geisler FH, Krassioukov A (2007) Hemodynamic parameters and timing of surgical decompression in acute cervical spinal cord injury. J Spinal Cord Med 30: 482–490

    PubMed  Google Scholar 

  10. Lehmann KG, Lane JG, Piepmeier JM, Batsford WP (1987) Cardiovascular abnormalities accompanying acute spinal cord injury in humans: incidence, time course and severity. J Am Coll Cardiol 10: 46–52

    Article  CAS  PubMed  Google Scholar 

  11. Piepmeier JM, Lehmann KB, Lane JG (1985) Cardiovascular instability following acute cervical spinal cord trauma. Cent Nerv Syst Trauma 2: 153–160

    CAS  PubMed  Google Scholar 

  12. Consortium for Spinal Cord Medicine (2008) Early acute management in adults with spinal cord injury: A clinical practice guideline for health-care professionals. J Spinal Cord Med 31: 403–479

    Google Scholar 

  13. Vale FL, Burns J, Jackson AB, Hadley MN (1997) Combined medical and surgical treatment after acute spinal cord injury: results of a prospective pilot study to assess the merits of aggressive medical resuscitation and blood pressure management. J Neurosurg 87: 239–246

    Article  CAS  PubMed  Google Scholar 

  14. Levi L, Wolf A, Belzberg H (1993) Hemodynamic parameters in patients with acute cervical cord trauma: description, intervention, and prediction of outcome. Neurosurgery 33: 1007–1016

    Article  CAS  PubMed  Google Scholar 

  15. Wolf A, Levi L, Mirvis S, Ragheb J, Huhn S, Rigamonti D, Robinson WL (1991) Operative management of bilateral facet dislocation. J Neurosurg 75: 883–890

    Article  CAS  PubMed  Google Scholar 

  16. Tator CH, Rowed DW, Schwartz ML, et al (1984) Management of acute spinal cord injuries. Can J Surg 27: 289–293

    CAS  PubMed  Google Scholar 

  17. Zach GA, Seiler W, Dollfus P (1976) Treatment results of spinal cord injuries in the Swiss Paraplegic Centre of Basle. Paraplegia 14: 58–65

    CAS  PubMed  Google Scholar 

  18. Bratton SL, Chestnut RM, Ghajar J, et al (2007) Guidelines for the management of severe traumatic brain injury. IX. Cerebral perfusion thresholds. J Neurotrauma 24(Suppl 1): S59–64

    Google Scholar 

  19. Rangel-Castilla L, Gasco J, Nauta HJ, Okonkwo DO, Robertson CS (2008) Cerebral pressure autoregulation in traumatic brain injury. Neurosurg Focus 25: E7

    Article  Google Scholar 

  20. Miyamoto K, Ueno A, Wada T, Kimoto S (1960) A new and simple method of preventing spinal cord damage following temporary occlusion of the thoracic aorta by draining the cerebrospinal fluid. J Cardiovasc Surg (Torino) 1: 188–197

    CAS  Google Scholar 

  21. Coselli JS, Lemaire SA, Koksoy C, Schmittling ZC, Curling PE (2002) Cerebrospinal fluid drainage reduces paraplegia after thoracoabdominal aortic aneurysm repair: results of a randomized clinical trial. J Vase Surg 35: 631–639

    Article  Google Scholar 

  22. Cina CS, Abouzahr L, Arena GO, Lagana A, Devereaux PJ, Farrokhyar F (2004) Cerebrospinal fluid drainage to prevent paraplegia during thoracic and thoracoabdominal aortic aneurysm surgery: A systematic review and meta-analysis. J Vase Surg 40: 36–44

    Article  Google Scholar 

  23. Kwon BK, Curt A, Belanger LM et al (2009) Intrathecal pressure monitoring and cerebrospinal fluid drainage in acute spinal card injury: A prospective randomized trial. J Neurosurg Spine 10: 181–193

    PubMed  Google Scholar 

  24. Contant CF, Valadka AB, Gopinath SP, Hannay HJ, Robertson CS (2001) Adult respiratory distress syndrome: A complication of induced hypertension after severe head injury. J Neurosurg 95: 560–568

    Article  CAS  PubMed  Google Scholar 

  25. Wynn MM, Mell MW, Tefera G, Hoch JR, Acher CW (2009) Complications of spinal fluid drainage in thoracoabdominal aortic aneurysm repair: A report of 486 patients treated from 1987 to 2008. J Vasc Surg 49: 29–34

    Article  PubMed  Google Scholar 

  26. Guha A, Tator CH, Rochon J (1989) Spinal cord blood flow and systemic blood pressure after experimental spinal cord injury in rats. Stroke 20: 372–377

    CAS  PubMed  Google Scholar 

  27. Levi L, Wolf A, Rigamonti D, Ragheb J, Mirvis S, Robinson WL (1991) Anterior decompression in cervical spine trauma: does the timing of surgery affect the outcome? Neurosurgery 29: 216–222

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Springer Science + Business Media Inc.

About this paper

Cite this paper

Solaiman, O., Zygun, D. (2010). Hemodynamic Management of Acute Spinal Cord Injury. In: Vincent, JL. (eds) Intensive Care Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-5562-3_37

Download citation

  • DOI: https://doi.org/10.1007/978-1-4419-5562-3_37

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4419-5561-6

  • Online ISBN: 978-1-4419-5562-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics