Expansive Duraplasty - Simple Technique with Promising Results in Complete Cervical Spinal Cord Injury: A Preliminary Study

Background: Complete cervical spinal cord injury is devastating with the currently available treatment modalities offering no hope for improvement. Intrathecal pressure is raised following spinal cord injury due to injured and edematous spinal cord. Due to constraints of the thecal sac, this sets up a vicious cascade leading to further spinal cord injury. Durotomy and expansile duraplasty could potentially prevent this secondary spinal cord injury. The aim of our study is to assess the advantage of durotomy and expansile duraplasty in addition to spinal bony decompression and fixation for traumatic cervical spine fracture. Methods: Two patients with posttraumatic complete cervical spinal cord injury (ASIA A) were managed with expansile duraplasty in addition to decompression and fixation. A thorough examination including perianal sensations and bulbocavernosus reflex was done to rule out the possibility of incomplete cord injury with spinal shock. Both the patients underwent posterior decompression and lax duraplasty. Standard protocols of spinal cord injury were followed like maintenance of MAP >85 mmHg. Results: Both the patients showed significant improvement in clinical status improving to ASIA D from ASIA A. Conclusion: Durotomy and duraplasty may be offered in all patients with complete spinal cord injury who are undergoing instrumentation.