The role of therapeutic hypothermia in the management of acute spinal cord injury

Authors

Nikolay L. Martirosyan, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States; Division of Neurosurgery, University of Arizona, Tucson, AZ, United States.Follow
Arpan A. Patel, College of Medicine, University of Arizona, Tucson, AZ, United States.
Alessandro Carotenuto, College of Medicine, University of Arizona, Tucson, AZ, United States.
M Yashar Kalani, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States.Follow
Michael A. Bohl, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States; Division of Neurosurgery, University of Arizona, Tucson, AZ, United States; College of Medicine, University of Arizona, Tucson, AZ, United States.Follow
Mark C. Preul, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States.
Nicholas Theodore, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States. Electronic address: Neuropub@dignityhealth.org.

Document Type

Article

Abstract

This review paper investigates the history, efficacy, and administration of systemic and local hypothermia for spinal cord injury (SCI). It summarizes the published experimental and clinical evidence on hypothermia for SCI and analyzes the potential for further research. Early experimental animal research showed that local hypothermia improved recovery and gain of function after acute SCI. However, in the early 1970s, clinical research findings did not coincide with results of these animal trials, which led to a loss of interest in local hypothermia. Since the 1980s, systemic hypothermia has been successfully used to treat SCI in both animals and humans. An abundance of positive evidence suggests that clinical trials are needed to determine the effectiveness of hypothermia for SCI. As a first step, we investigated the published clinical and experimental evidence on the use of hypothermia for SCI patients, who have few available treatment options. We searched PubMed for English-language reports published from 1940 to 2016 containing terms related to SCI treatment using hypothermia. We reviewed all articles on local hypothermia and acute SCI or on systemic hypothermia and acute SCI. Bibliographies of retrieved publications were also screened for additional citations. Ninety-six papers were selected. The clinical use of hypothermia is most successful if applied according to certain optimized parameters (e.g., duration, temperature, time from injury to initiation of cooling, and rewarming time). Preliminary data suggest that modest systemic hypothermia applied for 48h provides the best therapeutic value, but the parameters for use of local hypothermia vary greatly. Experimental evidence and some clinical evidence suggest that both local hypothermia and systemic hypothermia are beneficial for acute SCI. Future research should focus on defining the optimal levels of parameters. Large, multicenter, controlled clinical trials are needed to investigate its therapeutic potential.

Medical Subject Headings

Animals; Humans; Hypothermia, Induced (methods); Spinal Cord Injuries (therapy)

Publication Date

3-1-2017

Publication Title

Clinical neurology and neurosurgery

E-ISSN

1872-6968

Volume

154

First Page

79

Last Page

88

PubMed ID

28131967

Digital Object Identifier (DOI)

10.1016/j.clineuro.2017.01.002

Recommended Citation

Martirosyan, Nikolay L.; Patel, Arpan A.; Carotenuto, Alessandro; Kalani, M Yashar; Bohl, Michael A.; Preul, Mark C.; and Theodore, Nicholas, "The role of therapeutic hypothermia in the management of acute spinal cord injury" (2017). Neurosurgery. 1726.
https://scholar.barrowneuro.org/neurosurgery/1726