Canadian-American Spinal Cord Perfusion Pressure and Biomarker Study

a study on Spinal Cord Injury Spinal Paralysis Fractured Spine

Summary

Eligibility
for people ages 17 years and up (full criteria)
Location
at UCSF
Dates
study started
completion around
Principal Investigator
by Anthony Digiorgio (ucsf)
Headshot of Anthony Digiorgio
Anthony Digiorgio

Description

Summary

This multicenter study will enroll 100 patients with acute traumatic cervical and thoracic SCI who have a lumbar intrathecal catheter inserted within 24 hours of their injury. The lumbar intrathecal catheter will be inserted pre-operatively for the measurement of ITP and the collection of cerebrospinal fluid (CSF) samples. SCPP will be calculated as the difference between MAP and the ITP.

There are two important distinct yet related objectives in this prospective interventional study.

  1. Determine the effect of SCPP maintenance ≥ 65 mmHg in acute SCI on neurologic recovery as measured by ASIA Impairment Scale (AIS) grade conversion and motor score improvement.
  2. Collect CSF and blood samples for the measurement of neurochemical biomarkers and storage for future biomarker discovery and validation studies.

Details

Objective 1. To determine if actively maintaining an SCPP of at least 65 mmHg with a combination of MAP augmentation and CSF drainage promotes better neurologic recovery than routine hemodynamic management that focuses solely on MAP augmentation.

Objective 2. To determine if actively maintaining an SCPP of at least 65 mmHg with a combination of MAP augmentation and CSF drainage will allow for a reduction in the usage of vasopressors in acute SCI.

Objective 3. To determine the feasibility of draining CSF to reduce ITP in the acute post-injury setting, when the cord may be swollen against the dura causing subarachnoid space occlusion at the injury site.

Objective 4. To determine if there are complications associated with the installation of the intrathecal catheter and drainage of CSF in the acute SCI patient.

Keywords

Acute Spinal Cord Injury, Acute Spinal Paralysis, Spinal Cord Injuries, SPINAL Fracture, SCI, Spinal Cord Injury, CSF, Biomarker, CSF pressure, Traumatic SCI, Perfusion pressure, Paralysis, Wounds and Injuries, Spinal Fractures, SCPP Management => 65 mmHg, SCP Pressure Management

Eligibility

You can join if…

Open to people ages 17 years and up

  • Male or Female ≥ 17 (or the provincial age of majority - depending on local REB guidelines)
  • Complete (AIS A) or incomplete (AIS B, C) acute traumatic spinal cord injury.
  • Bony spinal levels between C0 and T12 inclusive.
  • Blunt (non-penetrating) spinal cord injury treated either surgically or non-surgically
  • Lumbar intrathecal catheter to be inserted as part of clinical hemodynamic management and CSF sample collected within 48 hours of injury
  • Initial blood sample collected within 24 hours of injury

You CAN'T join if...

  • Motor incomplete spinal cord injury AIS D (i.e. at least half (half or more) of the key muscle functions below the neurological level of injury (NLI) have a muscle grade greater than or equal to 3/5)
  • Spinal cord injury with sensory deficit only (i.e. no motor deficit)
  • Penetrating spinal cord injury (including gunshot wounds)
  • Isolated radiculopathy
  • Isolated cauda equina injury or spinal injury below L1
  • Associated injury (soft tissue or bony) to the lumbar spine where the intrathecal catheter would be placed
  • Associated traumatic conditions that would interfere with the outcome assessment (e.g., traumatic brain injury, chest, pelvis, abdomen, or femur injury requiring operative intervention)
  • Pre-existing neurodegenerative disorder, such as Parkinson's disease, Alzheimer's disease, Huntington's disease, multiple sclerosis, amyotrophic lateral sclerosis
  • Pre-existing thromboembolic disease or coagulopathy, such as hemophilia, von Willebrand disease
  • Presence of systemic disease that might interfere with patient safety, compliance or evaluation of the condition under study (e.g., clinically significant cardiac disease, HIV, Hep B or C) HTLV-1
  • Pre-existing inflammatory or autoimmune disorder (e.g. rheumatoid arthritis, systemic lupus, psoriasis, or ankylosing spondylitis
  • Any other medical condition that in the investigator's opinion would render the protocol procedures dangerous or impair the ability of the patient to receive protocol therapy
  • Female patients who are pregnant

Locations

  • Zuckerberg San Francisco General Hospital and Trauma Center accepting new patients
    San Francisco California 94110 United States
  • University of New Mexico Health Sciences Center accepting new patients
    Albuquerque New Mexico 87131 United States

Lead Scientist at University of California Health

  • Anthony Digiorgio (ucsf)
    Anthony DiGiorgio, DO, MHA is an assistant professor in the department of neurological surgery at the University of California, San Francisco. He received his DO degree from Touro University of Osteopathic Medicine in Vallejo, CA and completed neurosurgery residency at Louisiana State University Health Sciences Center in New Orleans, LA.

Details

Status
accepting new patients
Start Date
Completion Date
(estimated)
Sponsor
University of British Columbia
ID
NCT03911492
Study Type
Interventional
Participants
Expecting 100 study participants
Last Updated