Cerebrospinal Fluid Pressure Dynamics as a Bedside Test in Traumatic Spinal Cord Injury to Assess Surgical Spinal Cord Decompression: Safety, Feasibility, and Proof-of-Concept.
Najmeh Kheram, Andrea Boraschi, Nikolai Pfender and 7 others
PMID 36919616WHAT IT FOUND
Bedside cerebrospinal fluid pressure measurements were safe in 11 spinal cord injury patients.
The test identified restricted fluid circulation in some cases, matching imaging findings. This small pilot suggests the method is feasible, but does not yet prove it improves clinical decisions or patient outcomes.
Key findings
01The bedside assessment was safe and feasible, with no adverse events or delays in all 11 patients.
02Altered pressure dynamics, specifically reduced cardiac-driven pulses, aligned with imaging evidence of restricted spinal canal space in some patients.
03The Valsalva maneuver response was reduced in patients with cervical injuries due to impaired abdominal and thoracic muscle force, not spinal compression.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The sample size was very small (11 patients), and the study was a proof-of-concept without a control group receiving standard care versus the new test. The study did not compare CSFP dynamics against the gold standard of MRI for all patients; some relied on CT-myelography or had no recent imaging. The Valsalva maneuver was not monitored with airway pressure, so the reduced response in SCI patients could not be fully distinguished from poor effort versus physiological changes. The study assessed safety and diagnostic accuracy but did not measure whether using this test improved neurological recovery or reduced the need for revision surgery.
Declared interests
The authors declared no conflicts of interest. Funding was provided by the Swiss Paraplegia Foundation, IRP - International Foundation for Research in Paraplegia, and the Swiss National Science Foundation.
The easy way to misread this
Do not interpret the reduced Valsalva pressure response as a sign of spinal cord compression. In cervical SCI patients, this finding is primarily due to impaired abdominal and thoracic muscle force, which prevents adequate pressure generation, rather than a blockage of cerebrospinal fluid.