• Lukas Grassner, Peter A Winkler, Martin Strowitzki, Volker Bühren, Doris Maier, and Michael Bierschneider.
• Center for Spinal Cord Injuries, Trauma Center Murnau, Murnau, Germany. lukas.grassner@googlemail.com.
• Eur Spine J. 2017 Jan 1; 26 (1): 20-25.

PurposeEarly surgical management after traumatic spinal cord injury (SCI) is nowadays recommended. Since posttraumatic ischemia is an important sequel after SCI, maintenance of an adequate mean arterial pressure (MAP) within the first week remains crucial in order to warrant sufficient spinal cord perfusion. However, the contribution of raised intraparenchymal and consecutively increased intrathecal pressure has not been implemented in treatment strategies.MethodsCase report and review of the literature.ResultsHere we report a case of a 54-year old man who experienced a thoracic spinal cord injury after a fall. CT-examination revealed complex fractures of the thoracic spine. The patient underwent prompt surgical intervention. Intraoperatively, fractured parts of the ascending Th5 facet joint were displaced into the spinal cord itself. Upon removal, excessive protruding of medullary tissue was observed over several minutes. This demonstrates the clinical relevance of increased intrathecal pressure in some patients.ConclusionMonitoring and counteracting raised intrathecal pressure should guide clinical decision-making in the future in order to ensure optimal spinal cord perfusion pressure for every affected individual.

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