Introduction: Chronic cystic cavitation is a known long-term sequela of spinal cord injury (SCI); however, the presence of a cavity within hours of injury has not been described. MR images typically demonstrate a compressed spinal cord and a clear cavity is rarely seen. This has led to the belief that insertion of a scaffold device into the injured spinal cord is not feasible. In an ongoing clinical trial to evaluate an investigational Neuro-Spinal Scaffold, pre-operative MR in all five subjects did not identify an intraparenchymal cavity.
Methods: Five patients with acute (range 7-83 hours) AIS A thoracic SCI undergoing implantation of the Scaffold had preoperative MR images to evaluate extent and location of injury. The surgical technique for implantation includes myelotomy followed by insertion of the Scaffold into the contusion cavity.
Results: MR studies demonstrated cord parenchymal damage in all cases. MR showed regions of edema and hemorrhage; however, no distinct cavity was visualized in any of the 5 cases. At surgery, following laminectomy and durotomy, a myelotomy was performed over the most visibly damaged segment of the cord. In each of the 5 cases, a clear intramedullary cavity was identified that allowed for safe Scaffold implantation.
Conclusions: The presence of an acute cavity within the contused cord following SCI has not been systematically described. During surgical intervention, the cavity is readily apparent following intraparenchymal access. This study clearly identified cavities in 5 patients which were not appreciated on the preoperative MR studies. As most treatments of SCI have not included opening of the dura and the intraparenchymal spaces, the release of pressure from this intervention allowed for identification of well-defined cavities into which a Scaffold can be placed with the potential to promote neural regeneration.
Patient Care: The results of this research inform the neurosurgical community about the presence of an intraspinal cavity acutely following spinal cord injury which may affect future care of these patients.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Describe the importance of MRI in diagnosing a potential cavity in the spinal cord of patients with acute SCI
2) Discuss, in small groups, the implications of the presence of a cavity acutely following non-penetrating spinal cord injury
3) Identify a potentially effective approach for treating acute complete thoracic spinal cord injury