Natus Resident/Fellow Award for Neurotrauma: Hyperosmolar therapy for acute traumatic spinal cord injury

Sunday, May 5, 2024

3:58 PM – 4:03 PM CT

Location: S403ab

Presenting Author(s)

Sanjay S. Dhall, MD

Professor, Chief of Neurosurgery
Harbor UCLA Medical Center
PALOS VERDES ESTATES, CA, US

Co-Author(s)

TJ Florence, MD PhD

Resident
UCLA Neurosurgery
Los Angeles, CA, US
Joel S. Beckett, MD MHS

Assistant Professor
UCLA Neurosurgery
Los Angeles, California, United States
MB

Manuel Buitrago Blanco, MD PhD

Associate Professor
UCLA Neurosurgery, United States
RE

Richard G. Everson, MD

Assistant Professor
Departments of Neurosurgery, Radiation Oncology, Head and Neck Surgery, Jonsson Comprehensive Cancer Center, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Los Angeles, CA
Los Angeles, California, United States
Langston T. Holly, MD

Chief, Spine Division
UCLA Neurosurgery
Los Angeles, CA, US
DL

Daniel Lu, MD PhD

Professor
UCLA Neurosurgery
Los Angeles, California, United States
Anshul Ratnaparkhi, n/a

Medical Student
University of Miami Miller School of Medicine
San Jose, California, United States
Ziad Rifi, n/a (he/him/his)

Medical Student
UCLA Geffen School of Medicine
Los Angeles, California, United States
Alex Valenzuela (he/him/his)

Medical Student
UCLA Geffen School of Medicine
Paul M. Vespa, MD (he/him/his)

Professor
UCLA Neurosurgery
Los Angeles, California, United States
Andrew Vivas, MD (he/him/his)

Assistant Clinical Professor
UCLA Neurosurgery
Los Angeles, California, United States
Peter B. Wu, MD

Resident
UCLA Neurosurgery
Los Angeles, California, United States
Isaac Yang, MD (he/him/his)

Professor of Neurosurgery
Departments of Neurosurgery, Radiation Oncology, Head and Neck Surgery, Jonsson Comprehensive Cancer Center, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Los Angeles, CA
Los Angeles, CA, US
David Zarrin, MSE

Medical Student
UCLA Medicine
Bethesda, MD, US
MZ

Michelle Zhang, n/a

Nursing Student
UCLA Geffen School of Medicine, United States

Disclosure(s):

Sanjay S. Dhall, MD: Globus Medical: Royalty Recipient (Ongoing); great circle technologies: Ownership or Partnership (Ongoing)

TJ Florence, MD PhD: HH Lee Foundation: Grant/Research Support (Terminated, July 1, 2023)

Isaac Yang, MD: Baxter: Consultant (Ongoing); Brainlab AG (Munich, Germany): Consultant (Ongoing), Grant/Research Support (Ongoing); Stryker Corp: Grant/Research Support (Ongoing)

David Zarrin, MSE: No financial relationships to disclose

Introduction: Hyperosmolar therapy is an important adjunct in the treatment of traumatic brain injury (TBI). Despite significant overlap in the pathophysiology of traumatic brain and spinal cord injury (SCI), there is no literature supporting the use of hyperosmolar therapy for acute SCI. We therefore set out to investigate potential benefits of hyperosmolar therapy in this novel context.

Methods: We created a database of neurotrauma ICU admissions over a 10 year period (2012-2022). We identified patients with isolated spinal cord injury without traumatic brain injury. Clinical variables were extracted by chart review. Statistical analysis was performed via custom scripts written in MATLAB.

Results: We identified 157 patients for analysis. Of these, 47 patients received 3% hypertonic saline (HTS); there was no significant difference in admission strength or injury level. Early infusion ( < 18 hr) of HTS was associated with enhanced recovery of ASIA motor score at discharge irrespective of surgical timing (7.17 vs 3.03, p = 0.030). This translated to a 14.5% increase in strength below the level of injury at discharge (20.0 vs 5.51%, p = 0.019). The effect demonstrated a tight temporal dependence: initiating infusion >24 hrs after presentation was not associated with motor improvement. Both early surgery and early HTS was associated with conversion from ASIA A to lower grade SCI (p = 0.000006); however, early hyperosmolar therapy was associated with greater probability of ASIA D or E at discharge (64.7% v 27.5%, p = 0.029). Per patient, relative hypernatremia was positively correlated with discharge strength, irrespective of hyperosmolar exposure (p = 0.031).

Conclusion : Our data demonstrate that early hypertonic saline administration is associated with a modest but significant improvement in motor outcome and ASIA grade following acute traumatic spinal cord injury. This suggests that hyperosmolar therapy may be useful in limiting the secondary injury cascades of both SCI and TBI. While prospective data is necessary, our work adds to mounting evidence that cranial neurotrauma principles applied to management of cord injury could result in superior outcomes.