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Title: Management of acute traumatic spinal cord injury
Author: Phang, Isaac Sng Khai
ISNI:       0000 0004 6060 9942
Awarding Body: St George's, University of London
Current Institution: St George's, University of London
Date of Award: 2016
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Traumatic spinal cord injury (TSCI) is a devastating condition. Most patients remain paralysed or wheelchair bound. After TSCI the injured cord swells and is compressed against the dura. My supervisors showed that, after TSCI, intraspinal pressure (ISP) rises and spinal cord perfusion pressure (SCPP) falls, leading to decreased spinal cord blood flow at the injury site. ISP can be monitored, but this is an invasive procedure that requires inserting a pressure probe at the injury site. My supervisors also showed that monitoring ISP and SCPP is feasible and helps guide management of TSCI patients in the intensive care unit. The thesis has five parts: 1) Study of the safety of ISP monitoring in TSCI patients. The data show that ISP monitoring is safe [42 patients]. 2) Study of the safety of performing magnetic resonance imaging (MRI) during ISP monitoring. The data show that MRI is safe with the ISP probe in situ [gel phantoms, 1 patient]. 3) Study of the pressure in and around the injured spinal cord. The data show that three intradural compartments form after TSCI, each with a different pressure profile. The data also show that subdural ISP is the same as intraparenchymal ISP at the injury site [1 patient]. 4) Study of whether laminectomy plus expansion duroplasty decompresses the injured spinal cord more effectively than laminectomy. The data show that laminectomy plus expansion duroplasty lowers ISP, increases SCPP and improves spinal pressure reactivity more than laminectomy [21 patients]. 5) Microdialysis monitoring from the injury site. The data show that increased SCPP is associated with improved metabolic profile at the injury site and that worse neurological status at presentation is associated with worse metabolic profile at the injury site. The data also suggest that the optimum SCPP is around 90 mmHg. Increasing SCPP improves the entry of intravenously administered drugs into the injury site [14 patients). The findings have important implications for the management of TSCI patients and the design of drug trials for TSCI.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available