Duraplasty promotes functional recovery by alleviating intraspinal pressure and edema following severe spinal cord compression injury in rabbits: Experimental studies

Chaohua Yang; Tao He; Jingjin Ma; Qing Wang; Song Wang; Gaoju Wang; Jin Yang; Zhiyu Chen; Qiaochu Li; Fangbiao Zhan; Changchun Jian; Daxiong Feng; Zhengxue Quan

doi:10.1016/j.spinee.2024.12.007

Duraplasty promotes functional recovery by alleviating intraspinal pressure and edema following severe spinal cord compression injury in rabbits: Experimental studies

Spine J. 2024 Dec 14:S1529-9430(24)01197-5. doi: 10.1016/j.spinee.2024.12.007. Online ahead of print.

Authors

Chaohua Yang¹, Tao He², Jingjin Ma³, Qing Wang⁴, Song Wang⁵, Gaoju Wang⁶, Jin Yang⁷, Zhiyu Chen⁸, Qiaochu Li⁹, Fangbiao Zhan¹⁰, Changchun Jian¹¹, Daxiong Feng¹², Zhengxue Quan¹³

Affiliations

¹ Department of orthopaedics, The Affiliated Hospital of Southwest Medical University, No.25 Taiping Street, Jiangyang District, Sichuan 646000, China;; Department of orthopedic surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing 400016, China;; Orthopedic laboratory of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing 400016, China. Electronic address: [email protected].
² Department of orthopaedic trauma, Chongqing General Hospital, Chongqing University, No.118 Xingguang Avenue, Liangjiang New District, Chongqing 401120, China. Electronic address: [email protected].
³ Department of orthopedic surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing 400016, China;. Electronic address: [email protected].
⁴ Department of orthopaedics, The Affiliated Hospital of Southwest Medical University, No.25 Taiping Street, Jiangyang District, Sichuan 646000, China;. Electronic address: [email protected].
⁵ Department of orthopaedics, The Affiliated Hospital of Southwest Medical University, No.25 Taiping Street, Jiangyang District, Sichuan 646000, China;. Electronic address: [email protected].
⁶ Department of orthopaedics, The Affiliated Hospital of Southwest Medical University, No.25 Taiping Street, Jiangyang District, Sichuan 646000, China;. Electronic address: [email protected].
⁷ Department of orthopaedics, The Affiliated Hospital of Southwest Medical University, No.25 Taiping Street, Jiangyang District, Sichuan 646000, China;. Electronic address: [email protected].
⁸ Department of orthopedic surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing 400016, China;. Electronic address: [email protected].
⁹ Department of orthopedic surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing 400016, China;. Electronic address: [email protected].
¹⁰ Department of orthopaedics, Chongqing University Three Gorges Hospital, School of Medicine, Chongqing University, Chongqing 404100, China. Electronic address: [email protected].
¹¹ Department of orthopedic surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing 400016, China;. Electronic address: [email protected].
¹² Department of orthopaedics, The Affiliated Hospital of Southwest Medical University, No.25 Taiping Street, Jiangyang District, Sichuan 646000, China;. Electronic address: [email protected].
¹³ Department of orthopedic surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing 400016, China;; Orthopedic laboratory of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing 400016, China. Electronic address: [email protected].

PMID: 39681280
DOI: 10.1016/j.spinee.2024.12.007

Abstract

Background: After acute traumatic spinal cord injury (tSCI), various surgical strategies have been developed to alleviate elevated intraspinal pressure (ISP) and secondary injury.

Purpose: Our study aimed to investigate the impacts of duraplasty and laminectomy on edema progression, perfusion and functional outcomes after severe balloon compression SCI.

Study design: In vivo animal study.

Methods: Closed balloon compression injuries were induced at the T7 level in rabbits using an inflated volume of 50 μl. Laminectomy (1-level laminectomy: 1-laminectomy; 3-level laminectomy: 3-laminectomy) and duraplasty were performed immediately after model generation. ISP was monitored using a SOPHYSA probe at the epicenter within 7 days post-SCI. Edema progression, perfusion and damage severity were evaluated by serial multisequence MRI scans, behavioral and bladder scores within 8 weeks post-SCI. Blood-spinal cord barrier (BSCB) permeability and histopathology were subsequently analyzed.

Results: After SCI, ISP was steeply elevated in the control and 1-laminectomy groups, peaking at 33.14±4.91 and 31.71±4.50 mmHg at 48 h post-SCI; whereas in the 3-laminectomy and duraplasty groups, ISP peaked at 29.43±4.04 and 12.14±1.86 mmHg (p<0.0001) at 72 h post-SCI. MRI and function scores showed that duraplasty significantly reduced the intramedullary lesion length (IMLL) and blood flow reduction ratio, and promoted fiber tract sparing and spinal cord functional recovery (p<0.01). Histopathology revealed that duraplasty significantly reduced BSCB permeability, tissue loss and inflammation and promoted axon preservation (p<0.01), while it did not increase early scar formation.

Conclusions: Duraplasty may alleviate secondary SCI and promote functional recovery. This neuroprotective mechanism may be related to reduced ISP and increased perfusion, resulting in reduced edema, BSCB permeability and inflammation and increased nerve fiber tract preservation.

Clinical significance: Duraplasty may promote functional recovery following severe tSCI patients, but further investigations are needed.

Keywords: Arterial spin labeling; Blood-spinal cord barrier; Diffusion tensor imaging; Duraplasty; Edema; Intraspinal pressure; Traumatic spinal cord injury.