Safety and Feasibility of Lumbar CSF Drainage with Intrathecal Pressure Monitoring in Acute Severe Spinal Cord Injury: A Randomized Pilot Trial.

Background: Spinal cord perfusion impairment is a critical secondary mechanism in acute spinal cord injury (SCI). Although lumbar cerebrospinal fluid (CSF) drainage is widely used in cardiothoracic surgery, its use in SCI remains limited. This study presents an evaluation of the safety and feasibility of lumbar CSF drainage with intrathecal pressure (ITP) and spinal cord perfusion pressure (SCPP) monitoring in acute SCI patients.

Methods: We conducted a prospective randomized pilot trial involving 21 patients with acute traumatic SCI (ASIA A-C). Twelve patients received continuous lumbar CSF drainage and SCPP monitoring over 72 hours, whereas nine received standard care. The primary outcome measured was the change in ASIA scores at 12 months. The secondary outcomes included ITP measurements, MAP requirements, and feasibility and safety data.

Results: The initial ITP in the drainage group averaged 15 mmHg and was reduced to 6 mmHg via controlled drainage. This group maintained lower MAPs (74 vs. 82 mmHg, p = 0.004) compared to the control group and required less vasopressor support. Neurologically, 4 patients in the drainage group improved to ASIA C or D, compared to 1 patient in the control group. The mean motor score improvement was greater in the drainage group (Δ11 vs. Δ7), although the difference was not statistically significant. No drainage-related complications occurred.

Conclusion: Lumbar CSF drainage is a safe and feasible intervention for the treatment of acute SCI, enabling tailored perfusion management. Although preliminary findings are promising, larger multicenter trials are needed to validate their clinical efficacy and define optimal SCPP targets.