Tight BP Control During Surgery for Spinal Cord Injury Tied to Better Outcomes

NEW YORK (Reuters Health) – For patients with a spinal cord injury, maintaining blood pressure within a tightly defined range during surgery is associated with better functional recovery, even in patients with the most-severe injuries, a new study suggests.

Predicting neurological recovery after spinal cord injury (SCI) is challenging. Using a machine-learning technique called topological data analysis (TDA), Dr. Abel Torres-Espin of the University of California, San Francisco, and colleagues previously found that mean arterial pressure during SCI surgery predicts long-term functional recovery in rodent models.

In their latest study, they applied the same machine-learning technique to intraoperative and neurological outcome data for 118 SCI patients.

They compared the estimated grade of injury on admission with the estimated grade of injury at discharge, using the American Spinal Injury Association Impairment Scale (AIS), which ranges from grade A (complete motor and sensory function loss below the level of injury) to grade E (normal sensation and full motor function).

Of the 42 patients whose injuries had improved by at least one AIS grade from admission to discharge, 18 had had a grade-A injury, eight grade-B, 11 grade-C and five grade-D.

The analysis suggested that time outside of an optimal mean arterial blood pressure range (hypotension or hypertension) during surgery was associated with lower likelihood of neurological recovery at hospital discharge.

Maximal neurological recovery was associated with mean arterial blood pressure maintained between 76 -104 mmHg and 76 – 117 mmHg, the team reports in the journal eLife.

Deviation from this optimal mean arterial blood pressure range during SCI surgery “predicts lower probability of neurological recovery and suggest new targets for therapeutic intervention,” they write.

“Damage to neurons in spinal cord injuries leads to dysregulation of blood pressure, which in turn limits the supply of blood and oxygen to stressed spinal cord tissue, exacerbating spinal neuron death. Thus, precise blood pressure management is a key target for spinal cord injury care,” Dr. Torres-Espin said in a news release.

SOURCE: https://bit.ly/3nlV2zz eLife, online November 16, 2021.

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