Expansion Duroplasty For Severe Cervical Spinal Cord Swelling After Traumatic Injury: A Step-by-Step Surgical Protocol.

Acute traumatic cervical spinal cord injury frequently leads to severe cord edema, elevated intraspinal pressure, reduced spinal cord perfusion, and progressive neurological deterioration. Conventional bony decompression via laminectomy may provide limited relief, as the non-elastic dura mater can continue to constrain the swollen spinal cord. Expansion duroplasty is designed to address this limitation by enlarging the intradural space using an artificial dural substitute, allowing controlled expansion of the injured spinal cord. This protocol describes patient positioning, selection of laminectomy levels based on preoperative magnetic resonance imaging, dural opening technique, preparation of an artificial dural substitute, suturing sequence, and postoperative strategies to mitigate cerebrospinal fluid leakage. Critical steps are highlighted to ensure a watertight closure, minimize infection risk, and optimize gravity-dependent wound drainage. Representative results include postoperative imaging demonstrating restoration of the cerebrospinal fluid space, reduced dural constriction, and absence of significant pseudomeningocele formation. This method is intended for patients with severe cervical spinal cord swelling within 72 hours of injury and can be implemented in centers with microsurgical spine expertise as an adjunct to standard decompression procedures.