Study investigated the effect of local hypothermia and rewarming on injury site physiology, metabolism, and inflammation in patients with thoracic traumatic spinal cord injury (TSCI). In five patients with acute severe TSCI, American spinal injuries association Impairment Scale grades A to C, cord hypothermia (33 degrees centigrade) was induced, then rewarming (37 degrees centigrade). A pressure probe and a microdialysis catheter were placed intradurally at the injury site to monitor intraspinal pressure (ISP), spinal cord perfusion pressure (SCPP), tissue metabolism and inflammation. Cord hypothermia-rewarming, applied to awake patients, did not cause discomfort or neurological deterioration. Cooling did not affect cord physiology (ISP, SCPP), but markedly altered cord metabolism (increased glucose, lactate, lactate/pyruvate ratio (LPR), glutamate; decreased glycerol) and markedly reduced cord inflammation. Compared with pre-cooling baseline, rewarming was associated with significantly worse cord physiology (increased ISP, decreased SCPP), cord metabolism (increased lactate, LPR; decreased glucose, glycerol) and cord inflammation. The study was terminated because three patients developed delayed wound infections. At 18-months, two patients improved and three stayed the same. The findings suggest that, after TSCI, hypothermia is potentially beneficial by reducing cord inflammation, though after rewarming these benefits are lost due to increases in cord swelling, ischemia and inflammation. The authors urge caution when using hypothermia-rewarming therapeutically in TSCI.
Author(s):
Gallagher, Mathew J. |Hogg, Florence R. A. |Kearney, Siobhan |Kopp, Marcel A. |Blex, Christian |Serdani, Leonarda |Sherwood, Oliver |Schwab, Jan M. |Zoumprouli, Argyro |Papadopoulos, Marios C. |Saadoun, Samira|
