Characterizing Neurologic Recovery after Acute Complete Traumatic Spinal Cord Injury in Relation to Hemodynamic Management with Lumbar Intrathecal Drains

In acute spinal cord injury (SCI) patients who had lumbar intrathecal catheters inserted for cerebrospinal fluid (CSF) drainage and augmentation of spinal cord perfusion pressure (SCPP), we sought to characterize how neurologic recovery was related to aspects of this hemodynamic management approach. This prospective multi-center nonrandomized interventional clinical trial was conducted at eight level-1 trauma centers in North America with specialized units for SCI care. Twenty-seven patients presenting with motor-sensory complete SCI (AIS grade A) had catheters inserted for up to 7-days post-injury for CSF drainage and SCPP augmentation. Mean arterial pressure, intrathecal pressure (ITP), SCPP, ITP waveform morphology, and CSF drainage volume were collected hourly. Neurologic assessments were repeated at 6-months post-injury to determine if AIS grade conversion/improvement had occurred. Hemodynamic measures associated with the outcome of being an AIS grade “converter” or “non-converter” were compared. Of the 27 AIS A participants at baseline, 8 experienced neurologic recovery reflected by AIS grade conversion at 6-month follow-up (converters); 19 remained AIS A (non-converters). Converters were characterized by a higher ITP, lower SCPP, greater CSF drainage volume, and a more pulsatile ITP waveform morphology than nonconverters. In patients with AIS A SCI, AIS grade conversion at 6 months was associated with a specific pattern of hemodynamic measures that we hypothesize reflect a complete decompression and restoration of CSF flow in the subarachnoid space at the injury site. These metrics may provide guidance and/or targets for future studies on the management of acute SCI.