There are currently no treatments and no way of identifying secondary spinal cord injury for patients who suffered from traumatic spinal cord injury (tSCI). Falls, vehicle accident, sports-related injury and violence are all some of the potential causes of tSCI. Secondary spinal cord injury is a subsequent phase that is biologically initiated after a tSCI. It causes further neurological damage in the spinal cord that largely contributes to unfavorable functional outcomes for the patient, even after decompression surgery for tSCI.
After a tSCI, swelling occurs in the thecal sac. The thecal sac is found underneath the bony vertebrae in a person’s spine, and it house the spinal cord and spinal cord fluid. These two components play a key role in neurological function as it is part of the central nervous system. An increased environmental pressure caused by the swelling then leads to decreased vascular blood flow to the injured site, causing vascular hypo-perfusion which a type of ischemia where the lack of oxygen is caused by low blood supply. This drastic change in the biological environment leads to secondary spinal cord injury. Hence, any further damage to the spinal cord will lead to even more noticeable physical dysfunction.
There are currently no ways to identify the regions in the spinal cord that are hypo-perfused. Surgical bony decompressions such as a laminectomy are done to treat and stabilize the damaged vertebrae but to also relieve the pressure in the thecal sac in hopes of decreasing the negative effects of secondary spinal cord injury. The actual effect on functional outcome is unsatisfactory. If hypo-perfused areas along the spinal cord could be identified, hemodynamic conditions can be recovered by testing potential treatments to achieve better functional outcomes in patients.
The Hofstetter lab has developed a method to identify regions of hypo-perfusion using contrast enhanced ultrasound (CEUS) imaging and have discovered that CEUS could also track hemodynamic progress post treatment by indirectly quantifying blood flow using certain metrics. Dural decompression in rats with spinal cord injury were observed to improve blood flow at the injured site because pressure was relieved in the thecal sac, showing promise for success in clinical trials. The lab is currently recruiting participants for the study to treat tSCI with a combinatorial neuroprotective treatment approach that consists of dural decompression and an anti-inflammatory drug.