PRESSURE IS KEY!

01/16/18

Pressure is key!

Relieving spinal pressure could improve recovery after spinal cord injury

The Wings for Life foundation supports promising spinal cord research projects across the globe, and the Wings for Life World Run supports the foundation. By running, rolling and walking on May 6 in the Wings for Life World Run, ordinary people have the chance to change the face of spinal cord injury forever - Wings for Life World Run helps to fund ground-breaking research into curing spinal cord injury.

 

UNDER PRESSURE

 

Immediately after injuring his spinal cord, Peter was able to speak, move his arms and call for help. But when he woke from an artificial coma a few days later, he needed artificial respiration, and he couldn’t communicate with his voice or his arms.

 

Peter is not alone in his experience. Many spinal cord injuries worsen after the accident, and patients lose control of further bodily function in a process called secondary injury, where cell death leads to inflammation and swelling that further damages tissue and worsens the injury.

 

THINGS ARE CHANGING

 

In intensive care (ICU), the doctors’ primary goal is to stabilise the patient, but two researchers in London, funded by Wings for Life, are exploring a way to save patients’ body functions by monitoring pressure in the injured spinal cord.

 

PRESSURE IS KEY

 

Limiting secondary injury and preventing intact nerves from dying has been the research focus for Prof. Marios Papadopoulos and Dr Samira Saadoun at St George’s University Hospital for the past ten years.

 

They’re working on relieving the pressure on the spinal cord caused by post-injury inflammation and swelling. “The higher the intra-spinal pressure, the more nerve cells are destroyed,” explains Saadoun. So the pair wants to identify the exact spinal cord pressure to determine optimal pressure conditions and protect the spinal cord from further damage.

 

MONITORING

 

 

After stabilising the spine, within two days of the injury and with the go-ahead from the patient, Papadopoulos places on the spinal cord a probe that measures, for a week, the pressure at the site of injury and transmits data from within the body to computer via a thin nylon cable. 

 

A second probe, attached to the tissue, provides information about the spinal cord’s metabolic condition: Whether the cells are still alive or if toxic substances are building up inside the tissue; whether they are getting enough oxygen and nutrients.

 

An increase in pressure and a worsening of tissue metabolism is a warning sign for doctors to relieve the pressure.

 

HOW DO THEY RELIEVE PRESSURE?

 

Decompressing by surgically removing vertebrae to give the swelling more roomCutting the dura mater, a thick membrane surrounding the spinal cord, to relieve pressureLying the patients on their side rather than on their backAdjusting blood pressure to give the tissue optimal blood and nutrient supply

 

LEVEL OF PARALYSIS DECREASES

 

Despite early concerns that the probes would cause infections or further spinal cord damage, Papadopoulos and Saadoun have found that by optimising the spinal cord perfusion pressure, patients often find their ability to feel below the injury site has improved, so the level of paralysis has decreased.

 

Papadopoulos is optimistic their technique could become widespread. “Some patients who would normally be completely paralysed will be able to leave the hospital with partial paralysis. For others, we will be able to decrease the level of paralysis by one or more segments. It does make a huge difference, after all, if you can move your fingers or not.”

 

THE FUTURE

 

 

Over the next few years, the researchers hope to learn more about optimal pressure conditions and whether the optimal perfusion pressure range changes during the healing process. They also want to know whether a change of pressure causes abnormal electrical activity in the injured spinal cord tissue.

 

To do that, Papadopoulos and Saadoun now have an engineer to handle the complex computing tasks. They are presenting their findings to the international ICU community, which means travel costs. Their aim to set a new care benchmark for treating patients with spinal cord injuries in five years’ time needs your help.

 

HOW WINGS FOR LIFE DONATIONS ARE PUT TO WORK

 

Running in the Wings for Life World Run or donating to Wings for Life ensures the clinical study can continue its potentially life-changing work. Papadopoulos and Saadoun use the money to pay for, among other things, 

 

* probes for pressure and micro-dialysis 
* analysis devices and chemicals 
* devices for measuring electrical activity 
* salary for the software engineer