Duraplasty in acute spinal cord injury: a systematic review.

BACKGROUND

Acute spinal cord injury (aSCI) can cause severe, lasting disabilities that may be fatal. Expansile duraplasty has been explored as a potential intervention aimed at alleviating spinal cord compression and enhancing neurological recovery in patients with aSCI.

OBJECTIVE

This systematic review aimed to assess efficacy, safety, and clinical outcomes of expansile duraplasty in the management of aSCI.

METHODS

The literature was searched across major databases to identify relevant studies published up to July 2024. The inclusion criteria encompassed studies involving human subjects with aSCI that underwent duraplasty. Data extraction focused on neurological outcomes, complications, and follow-up duration.

RESULTS

Four studies met the inclusion criteria, comprising a total of 158 patients with aSCI of which 35 patients underwent duraplasty. The average age of these patients was 50.2 years ± 15.5. Among these patients, 77.8% (123 patients) underwent decompression alone, while 22.2% (35 patients) underwent decompression combined with duraplasty. Improvements in the American Spinal Injury Association Impairment Scale (AIS) were reported in two studies, wherein 3/23 patients improved from grade A to grades C or D; 14/23 patients improved from grade B to grades C, D, or E; and 3/23 patients improved from grade C to grades D or E. Three studies detailed changes in spinal cord perfusion pressure indices, displaying significant improvement in intraspinal pressure, spinal cord perfusion pressure, and spinal cord pressure reactivity.

CONCLUSION

Expansile duraplasty shows promise in patients with aSCI and may be effective in enhancing patient outcomes. Current literature remains scarce and further studies need to be conducted.