Monitoring from the Injury Site After Spinal Cord Injury: Case Series of 109 Patients from Five Intensive Care Units.

BACKGROUND: We review the international experience of placing monitoring probes intrathecally at the injury site in patients with acute, severe traumatic spinal cord injuries. The aims are to assess the types of probes used, their placement, signal quality, and safety. METHODS: We analyzed data from 109 adult patients managed in intensive care units in Aarhus, Leuven, Ljubljana, London, and Madrid. A questionnaire was distributed to all participating sites and data were retrospectively collected from each patient's medical record. RESULTS: Admission American Spinal Injury Association (AIS) grade was A (58.7%), B (19.3%), or C (22.0%). The probes remained for 5.3 ± 0.2 days (mean ± standard error). All patients had intraspinal pressure probes, 67.9% also had microdialysis probes, and 44.0% also had oxygen probes. Signal quality was good most of the time in 89.0% (intraspinal pressure), 95.9% (microdialysis), and 79.2% (oxygen) of patients. Computed tomography (CT) obtained in 89.0% of patients confirmed good probe position in all but one patient. Cerebrospinal fluid leak occurred in 20.8% of patients, 81.8% of whom required bedside suturing, 9.1% of whom required lumbar drainage, and 9.1% of whom required probe removal. Pseudomeningocele developed in 10.4% patients, of whom 81.8% were asymptomatic and 18.2% required surgery. Wound infections were reported in 4.7% patients: 60.0% resolved with antibiotics and 40.0% required surgical debridement. There was no spinal cord damage, meningitis, or hematoma. Though the probe signals were used for research, we show examples of potential clinical value. The probes allow for visualization in real time of spinal cord perfusion pressure, spinal cord autoregulation, spinal cord tissue oxygenation, and metabolism. CONCLUSIONS: The main risks of intrathecal monitoring probes are cerebrospinal fluid leak, pseudomeningocele, and wound infection. Spinal cord damage, meningitis, or hematoma have not been observed. The probes provide good quality data in most patients with acute, severe traumatic spinal cord injuries that could potentially be used to guide clinical management.