Neurosurgery notes/Intraspinal pressure (ISP)

Intraspinal pressure (ISP)

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Spinal cord injury
RAG
RAG
Last edited time
Jul 13, 2026 08:10 PM GMT+0
  • Reference
  • After severe TSCI,
    • Intraspinal pressure (ISP) is high (typically 20-40 mmHg)
    • Spinal cord perfusion pressure (SCPP) low (typically 40-60 mmHg).
  • The following has little effect on ISP after TSCI.
    • Mannitol administration
    • Reduction in PaCO₂
    • Increase in sevoflurane
  • Factors that increase SCPP
    • Inotropes caused an increase in ISP and MAP but with a net increase in SCPP.
      • By intervening to increase SCPP, we could improve outcome in some patients as assessed using motor evoked potentials and a limb motor score.
  • Laminectomy + duroplasty > Laminectomy alone (awaiting DISCUS trial)
    • Bony decompression without dural opening have not convincingly shown a beneficial effect on outcome.
    • Laminectomy + duroplasty group
      • ISP was lower, SCPP higher, and sPRx lower, (i.e. improved vascular pressure reactivity), compared with the laminectomy group.
      • Complications
        • Laminectomy + duroplasty caused
          • CSF leak that settled with lumbar drain in one patient
          • Pseudomeningocele that resolved completely in five patients.
      • Change in ASIA grade (ASIA grade at follow-up minus ASIA grade at presentation), walking ability, bladder function, and bowel function were better in the laminectomy+duroplasty versus the laminectomy group, though not significant (p < 0.05) and assessed at significantly different time points post-injury (10 months vs. 25 months post-injury, respectively)