We review state-of-the-art monitoring techniques for acute, severe traumatic spinal cord injury (TSCI) to facilitate targeted perfusion of the injured cord rather than applying universal mean arterial pressure targets. Key concepts are discussed such as intraspinal pressure and spinal cord perfusion pressure (SCPP) at the injury site, respectively, analogous to intracranial pressure and cerebral perfusion pressure for traumatic brain injury. The concept of spinal cord autoregulation is introduced and quantified using spinal pressure reactivity index (sPRx), which is analogous to pressure reactivity index for traumatic brain injury. The U-shaped relationship between sPRx and SCPP defines the optimum SCPP as the SCPP that minimizes sPRx (i.e., maximizes autoregulation), and suggests that not only ischemia but also hyperemia at the injury site may be detrimental. The observation that optimum SCPP varies between patients and temporally in each patient supports individualized management. We discuss multimodality monitoring, which revealed strong correlations between SCPP and injury site metabolism (tissue glucose, lactate, pyruvate, glutamate, glycerol), monitored by surface microdialysis. Evidence is presented that the dura is a major, but unappreciated, cause of spinal cord compression after TSCI; we thus propose expansion duroplasty as a novel treatment. Monitoring spinal cord blood flow at the injury site has revealed novel phenomena, e.g., 3 distinct blood flow patterns, local steal, and diastolic ischemia. We conclude that monitoring from the injured spinal cord in the intensive care unit is a safe technique that appears to enable optimized and individualized spinal cord perfusion.

中文翻译：

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脊髓创伤的靶向灌注治疗。

我们回顾了针对急性，严重创伤性脊髓损伤（TSCI）的最新监测技术，以促进对受损脊髓的靶向灌注，而不是应用普遍平均动脉压目标。讨论了关键概念，例如损伤部位的脊髓内压和脊髓灌注压（SCPP），分别类似于颅脑压和脑灌注压治疗颅脑外伤。脊髓自动调节的概念是通过使用脊髓压力反应指数（sPRx）引入和量化的，该指数类似于创伤性脑损伤的压力反应指数。sPRx和SCPP之间的U形关系将最佳SCPP定义为使sPRx最小化（即，最大化自动调节）的SCPP，并表明不仅缺血，而且损伤部位的充血也可能有害。最佳SCPP在患者之间以及每个患者的时间上有所不同的观察结果支持个性化管理。我们讨论了多模态监测，该监测揭示了SCPP与损伤部位代谢（组织葡萄糖，乳酸，丙酮酸，谷氨酸，甘油）之间的密切相关性，通过表面微透析监测。有证据表明，硬脑膜是TSCI后脊髓压迫的主要原因，但尚不明确。因此，我们提出扩张硬膜成形术作为一种新的治疗方法。监测损伤部位的脊髓血流发现了新颖的现象，例如3种不同的血流模式，局部窃血和舒张期缺血。