Object: Extradural decompression supplemented with stabilization of the injured vertebral segment is the gold standard for treating traumatic spines. Any effective surgical modality should not only be undoing the reversible harm caused by the primary cord injury but should also be contributing to reduce the potential deleterious effects of the secondary cord injury including the increased intra-thecal Pressure (ITP) inside relatively non-compliant intact dura. ITP has been reported to be increased after decompression but distal to the site of injury which actually may reduce vascular perfusion of the cord and be negating the likely benefits of the performed surgery. The objective of the present study was to evaluate the effect of surgical decompression on ITP both proximal and distal to the level of injury and exploring decompression’s true efficacy in acutely injured thoracic spinal cord injury (SCI). Methods: The present study comprised of twenty patients of thoracic spine injury presenting within 7 days of injury who underwent surgical decompression and posterior instrumentation. After giving general anaesthesia, all patients were put in prone position on the operating table keeping both the hips flexed to nearly 60 degrees using bolster under torso to open up interlaminar spaces. Lumbar puncture (LP) was performed through L4-5 space using 18 G epidural needle inserting a catheter and connecting it to pressure transducer to record intra thecal pressure. Midline posterior approach was utilized for exposing the injury site. Another epidural needle was inserted percutaneously and manoeuvred through an interlaminar window created through the inter-laminar space proximal to the site of injury. A second catheter was inserted through this needle into the intrathecal space and connected to another pressure transducer and the monitor. Decompression and posterior instrumentation were done in the standard manner. Both catheters proximal and distal to site of injury recorded the ITP before, during and after the decompression and were maintained for 72 hours. Results: Surgical decompression produced reduction in ITP proximal to the level of cord injury while it caused no change in ITP distal to the cord injury. Mean ITP proximal to the cord injury before and after decompression was 24.70± 6.78 and 19.10± 4.16. Mean ITP distal to the cord injury before and after decompression were 17.25 ± 5.36 and 17.15 ± 5.03 respectively. No adverse events related to pressure monitoring were noted in any patient. Conclusions: Surgical decompression in acute SCI not only removes the extradural compression but also restores flow of the cerebrospinal fluid (CSF) and normalizes increased ITP all along the thecal sac. Decreased ITP both proximal and distal to the site of injury brings improvement in the spinal cord perfusion pressure (SCPP) further enlarging benefits of the surgical decompression.

Object: Extradural decompression supplemented with stabilization of the injured vertebral segment is the gold standard for treating traumatic spines. Any effective surgical modality should not only be undoing the reversible harm caused by the primary cord injury but should also be contributing to reduce the potential deleterious effects of the secondary cord injury including the increased intra-thecal Pressure (ITP) inside relatively non-compliant intact dura. ITP has been reported to be increased after decompression but distal to the site of injury which actually may reduce vascular perfusion of the cord and be negating the likely benefits of the performed surgery. The objective of the present study was to evaluate the effect of surgical decompression on ITP both proximal and distal to the level of injury and exploring decompression’s true efficacy in acutely injured thoracic spinal cord injury (SCI). Methods: The present study comprised of twenty patients of thoracic spine injury presenting within 7 days of injury who underwent surgical decompression and posterior instrumentation. After giving general anaesthesia, all patients were put in prone position on the operating table keeping both the hips flexed to nearly 60 degrees using bolster under torso to open up interlaminar spaces. Lumbar puncture (LP) was performed through L4-5 space using 18 G epidural needle inserting a catheter and connecting it to pressure transducer to record intra thecal pressure. Midline posterior approach was utilized for exposing the injury site. Another epidural needle was inserted percutaneously and manoeuvred through an interlaminar window created through the inter-laminar space proximal to the site of injury. A second catheter was inserted through this needle into the intrathecal space and connected to another pressure transducer and the monitor. Decompression and posterior instrumentation were done in the standard manner. Both catheters proximal and distal to site of injury recorded the ITP before, during and after the decompression and were maintained for 72 hours. Results: Surgical decompression produced reduction in ITP proximal to the level of cord injury while it caused no change in ITP distal to the cord injury. Mean ITP proximal to the cord injury before and after decompression was 24.70± 6.78 and 19.10± 4.16. Mean ITP distal to the cord injury before and after decompression were 17.25 ± 5.36 and 17.15 ± 5.03 respectively. No adverse events related to pressure monitoring were noted in any patient. Conclusions: Surgical decompression in acute SCI not only removes the extradural compression but also restores flow of the cerebrospinal fluid (CSF) and normalizes increased ITP all along the thecal sac. Decreased ITP both proximal and distal to the site of injury brings improvement in the spinal cord perfusion pressure (SCPP) further enlarging benefits of the surgical decompression.