Cerebrospinal Fluid Drainage (CSFD) in Acute Spinal Cord Injury
NCT ID: NCT02495545
Last Updated: 2019-11-27
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
Get a concise snapshot of the trial, including recruitment status, study phase, enrollment targets, and key timeline milestones.
COMPLETED
NA
15 participants
INTERVENTIONAL
2015-10-31
2019-10-25
Brief Summary
Review the sponsor-provided synopsis that highlights what the study is about and why it is being conducted.
Related Clinical Trials
Explore similar clinical trials based on study characteristics and research focus.
Comparison of Antibiotic Protocols in Spine Patients With Postoperative Drains
NCT01608854
A Prospective, Randomized Comparison Of Drainage Techniques After One- Or Two-Level Open Posterior Lumbar Decompression Or Decompression And Fusion
NCT06820736
Non-surgical Spinal Decompression Therapy and Outcomes
NCT06525896
Duraplasty for Acute Traumatic Spinal Cord Injury
NCT07280351
Irrigation Endoscopic Decompression
NCT02254590
Detailed Description
Dive into the extended narrative that explains the scientific background, objectives, and procedures in greater depth.
Conditions
See the medical conditions and disease areas that this research is targeting or investigating.
Study Design
Understand how the trial is structured, including allocation methods, masking strategies, primary purpose, and other design elements.
RANDOMIZED
PARALLEL
TREATMENT
NONE
Study Groups
Review each arm or cohort in the study, along with the interventions and objectives associated with them.
CSFD with elevation of MAP
Subjects will receive CSFD and elevation of MAP. Treatments will be 120 hours (5 days) from time treatment is initiated (time 0), and within 24 hours of time of injury. Initiation of CSFD will occur after decompression (during surgery) with a target ITP of 10 mmHg. MAP elevation (norepinephrine drip; goal 100-110 mmHg) will start during surgery, simultaneously with CSFD. 10 mL of CSF will be collected daily for routine lab testing. Post-surgery subjects will be transferred to an intensive care unit (ICU) for duration of treatment or longer if clinically indicated. Target MAP will be sustained within 100-110 mmHg for 5 days. Norepinephrine drip will be used to maintain MAP goal. Subjects will receive other treatment per standard of care at the participating investigational sites.
CSFD and elevation of MAP
Lumbar drain placement with CSFD with elevation of MAP
Maintenance of MAP
Subjects will receive elevation of MAP (norepinephrine drip; goal 85-90 mm Hg). Target MAP will be sustained within 85-90 mmHg in the control group for 5 days. Duration of elevation of MAP treatment will be 120 hours (5 days) from time treatment is (time 0). Subjects will receive the same treatment as the subjects in investigational arm except for the initiation of the CSFD and less aggressive MAP elevation. They will have a drain placed the same way as the experimental subjects. While drain is in place, 10 mL of cerebrospinal fluid will be collected daily for laboratory testing. After that, ITP will be monitored but CSFD will not be initiated. Subjects will receive other treatment per standard of care at participating investigational sites.
Maintenance of MAP
Lumbar drain placement without CSFD and with maintenance of MAP
Interventions
Learn about the drugs, procedures, or behavioral strategies being tested and how they are applied within this trial.
CSFD and elevation of MAP
Lumbar drain placement with CSFD with elevation of MAP
Maintenance of MAP
Lumbar drain placement without CSFD and with maintenance of MAP
Eligibility Criteria
Check the participation requirements, including inclusion and exclusion rules, age limits, and whether healthy volunteers are accepted.
Inclusion Criteria
* Diagnosis of acute SCI;
* Injury is less than 24 hours old;
* ISNCSCI Impairment Scale Grade "A," "B" or "C" based upon first ISNCSCI evaluation after arrival to the hospital;
* Neurological level of injury between C4-C8 based upon first ISNCSCI evaluation after arrival to the hospital;
* Women of childbearing potential must have a negative serum β-hCG pregnancy test or a negative urine pregnancy test;
* Patient is willing to participate in the study;
* Informed consent document signed by patient or witnessed informed consent document;
* No contraindications for study treatment(s);
* Able to cooperate in the completion of a standardized neurological examination by ISNCSCI standards (includes patients who are on a ventilator).
Exclusion Criteria
* Significant concomitant head injury defined by a Glasgow Coma Scale (GCS) score \< 14 with a clinically significant abnormality on a head CT (head CT required only for patients suspected to have a brain injury at the discretion of the investigator);
* Pre-existing neurologic or mental disorder which would preclude accurate evaluation and follow-up (i.e. Alzheimer's disease, Parkinson's disease, unstable psychiatric disorder with- hallucinations and/or delusions or schizophrenia);
* Prior history of SCI;
* Recent history (less than 1 year) of chemical substance dependency or significant psychosocial disturbance that may impact the outcome or study participation, in the opinion of the investigator;
* Is a prisoner;
* Participation in another clinical trial within the past 30 days;
* Acquired immune deficiency syndrome (AIDS) or AIDS-related complex;
* Active malignancy or history of invasive malignancy within the last five years, with the exception of superficial basal cell carcinoma or squamous cell carcinoma of the skin that has been definitely treated. Patients with carcinoma in situ of the uterine cervix treated definitely more than 1 year prior to enrollment may enter the study.
18 Years
75 Years
ALL
No
Sponsors
Meet the organizations funding or collaborating on the study and learn about their roles.
University of Miami
OTHER
St. Joseph's Hospital and Medical Center, Phoenix
OTHER
Responsible Party
Identify the individual or organization who holds primary responsibility for the study information submitted to regulators.
Principal Investigators
Learn about the lead researchers overseeing the trial and their institutional affiliations.
Nicholas Theodore, MD
Role: PRINCIPAL_INVESTIGATOR
Barrow Neurological Institute, St. Joseph's Hospital and Medical Center
Locations
Explore where the study is taking place and check the recruitment status at each participating site.
University of Alabama School of Medicine Department of Neurosurgery
Birmingham, Alabama, United States
Barrow Neurological Institute St. Joseph's Hospital and Medical Center
Phoenix, Arizona, United States
University of Arizona Department of Surgery Division of Neurosurgery
Tucson, Arizona, United States
Countries
Review the countries where the study has at least one active or historical site.
References
Explore related publications, articles, or registry entries linked to this study.
Amar AP, Levy ML. Pathogenesis and pharmacological strategies for mitigating secondary damage in acute spinal cord injury. Neurosurgery. 1999 May;44(5):1027-39; discussion 1039-40. doi: 10.1097/00006123-199905000-00052.
Bernhard M, Gries A, Kremer P, Bottiger BW. Spinal cord injury (SCI)--prehospital management. Resuscitation. 2005 Aug;66(2):127-39. doi: 10.1016/j.resuscitation.2005.03.005.
Brown PD, Davies SL, Speake T, Millar ID. Molecular mechanisms of cerebrospinal fluid production. Neuroscience. 2004;129(4):957-70. doi: 10.1016/j.neuroscience.2004.07.003.
Burke DA, Linden RD, Zhang YP, Maiste AC, Shields CB. Incidence rates and populations at risk for spinal cord injury: A regional study. Spinal Cord. 2001 May;39(5):274-8. doi: 10.1038/sj.sc.3101158.
Casha S, Christie S. A systematic review of intensive cardiopulmonary management after spinal cord injury. J Neurotrauma. 2011 Aug;28(8):1479-95. doi: 10.1089/neu.2009.1156. Epub 2010 Apr 8.
Coselli JS, LeMaire SA, Koksoy C, Schmittling ZC, Curling PE. Cerebrospinal fluid drainage reduces paraplegia after thoracoabdominal aortic aneurysm repair: results of a randomized clinical trial. J Vasc Surg. 2002 Apr;35(4):631-9. doi: 10.1067/mva.2002.122024.
DeVivo MJ, Chen Y. Trends in new injuries, prevalent cases, and aging with spinal cord injury. Arch Phys Med Rehabil. 2011 Mar;92(3):332-8. doi: 10.1016/j.apmr.2010.08.031.
Dohrmann GJ, Wick KM, Bucy PC. Spinal cord blood flow patterns in experimental traumatic paraplegia. J Neurosurg. 1973 Jan;38(1):52-8. doi: 10.3171/jns.1973.38.1.0052. No abstract available.
Fehlings MG, Tator CH, Linden RD. The relationships among the severity of spinal cord injury, motor and somatosensory evoked potentials and spinal cord blood flow. Electroencephalogr Clin Neurophysiol. 1989 Jul-Aug;74(4):241-59. doi: 10.1016/0168-5597(89)90055-5.
Francel PC, Long BA, Malik JM, Tribble C, Jane JA, Kron IL. Limiting ischemic spinal cord injury using a free radical scavenger 21-aminosteroid and/or cerebrospinal fluid drainage. J Neurosurg. 1993 Nov;79(5):742-51. doi: 10.3171/jns.1993.79.5.0742.
Guha A, Tator CH, Rochon J. Spinal cord blood flow and systemic blood pressure after experimental spinal cord injury in rats. Stroke. 1989 Mar;20(3):372-7. doi: 10.1161/01.str.20.3.372.
Hadley MN, Walters BC. Introduction to the Guidelines for the Management of Acute Cervical Spine and Spinal Cord Injuries. Neurosurgery. 2013 Mar;72 Suppl 2:5-16. doi: 10.1227/NEU.0b013e3182773549. No abstract available.
Hadley MN, Walters BC, Grabb PA, Oyesiku NM, Przybylski GJ, Resnick DK, Ryken TC, Mielke DH. Guidelines for the management of acute cervical spine and spinal cord injuries. Clin Neurosurg. 2002;49:407-98. No abstract available.
Hickey R, Albin MS, Bunegin L, Gelineau J. Autoregulation of spinal cord blood flow: is the cord a microcosm of the brain? Stroke. 1986 Nov-Dec;17(6):1183-9. doi: 10.1161/01.str.17.6.1183.
Horn EM, Theodore N, Assina R, Spetzler RF, Sonntag VK, Preul MC. The effects of intrathecal hypotension on tissue perfusion and pathophysiological outcome after acute spinal cord injury. Neurosurg Focus. 2008;25(5):E12. doi: 10.3171/FOC.2008.25.11.E12.
Kindt GW. Autoregulation of spinal cord blood flow. Eur Neurol. 1971-1972;6(1):19-23. doi: 10.1159/000114459. No abstract available.
Kobrine AI, Doyle TF, Martins AN. Autoregulation of spinal cord blood flow. Clin Neurosurg. 1975;22:573-81. doi: 10.1093/neurosurgery/22.cn_suppl_1.573.
Kobrine AI, Evans DE, Rizzoli HV. The role of the sympathetic nervous system in spinal cord autoregulation. Acta Neurol Scand Suppl. 1977;64:54-5. No abstract available.
Kwon BK, Curt A, Belanger LM, Bernardo A, Chan D, Markez JA, Gorelik S, Slobogean GP, Umedaly H, Giffin M, Nikolakis MA, Street J, Boyd MC, Paquette S, Fisher CG, Dvorak MF. Intrathecal pressure monitoring and cerebrospinal fluid drainage in acute spinal cord injury: a prospective randomized trial. J Neurosurg Spine. 2009 Mar;10(3):181-93. doi: 10.3171/2008.10.SPINE08217.
Martirosyan NL, Feuerstein JS, Theodore N, Cavalcanti DD, Spetzler RF, Preul MC. Blood supply and vascular reactivity of the spinal cord under normal and pathological conditions. J Neurosurg Spine. 2011 Sep;15(3):238-51. doi: 10.3171/2011.4.SPINE10543. Epub 2011 Jun 10.
Mokri B. The Monro-Kellie hypothesis: applications in CSF volume depletion. Neurology. 2001 Jun 26;56(12):1746-8. doi: 10.1212/wnl.56.12.1746.
Palesch YY, Tilley BC, Sackett DL, Johnston KC, Woolson R. Applying a phase II futility study design to therapeutic stroke trials. Stroke. 2005 Nov;36(11):2410-4. doi: 10.1161/01.STR.0000185718.26377.07. Epub 2005 Oct 13.
Piano G, Gewertz BL. Mechanism of increased cerebrospinal fluid pressure with thoracic aortic occlusion. J Vasc Surg. 1990 May;11(5):695-701. doi: 10.1067/mva.1990.19358.
Ploumis A, Yadlapalli N, Fehlings MG, Kwon BK, Vaccaro AR. A systematic review of the evidence supporting a role for vasopressor support in acute SCI. Spinal Cord. 2010 May;48(5):356-62. doi: 10.1038/sc.2009.150. Epub 2009 Nov 24.
Rowland JW, Hawryluk GW, Kwon B, Fehlings MG. Current status of acute spinal cord injury pathophysiology and emerging therapies: promise on the horizon. Neurosurg Focus. 2008;25(5):E2. doi: 10.3171/FOC.2008.25.11.E2.
Royston P, Barthel FM, Parmar MK, Choodari-Oskooei B, Isham V. Designs for clinical trials with time-to-event outcomes based on stopping guidelines for lack of benefit. Trials. 2011 Mar 18;12:81. doi: 10.1186/1745-6215-12-81.
Ryken TC, Hurlbert RJ, Hadley MN, Aarabi B, Dhall SS, Gelb DE, Rozzelle CJ, Theodore N, Walters BC. The acute cardiopulmonary management of patients with cervical spinal cord injuries. Neurosurgery. 2013 Mar;72 Suppl 2:84-92. doi: 10.1227/NEU.0b013e318276ee16. No abstract available.
Sekhon LH, Fehlings MG. Epidemiology, demographics, and pathophysiology of acute spinal cord injury. Spine (Phila Pa 1976). 2001 Dec 15;26(24 Suppl):S2-12. doi: 10.1097/00007632-200112151-00002.
Senter HJ, Venes JL. Loss of autoregulation and posttraumatic ischemia following experimental spinal cord trauma. J Neurosurg. 1979 Feb;50(2):198-206. doi: 10.3171/jns.1979.50.2.0198.
Smith AJ, McCreery DB, Bloedel JR, Chou SN. Hyperemia, CO2 responsiveness, and autoregulation in the white matter following experimental spinal cord injury. J Neurosurg. 1978 Feb;48(2):239-51. doi: 10.3171/jns.1978.48.2.0239.
Svensson LG, Crawford ES, Hess KR, Coselli JS, Safi HJ. Experience with 1509 patients undergoing thoracoabdominal aortic operations. J Vasc Surg. 1993 Feb;17(2):357-68; discussion 368-70.
Sydes MR, Parmar MK, Mason MD, Clarke NW, Amos C, Anderson J, de Bono J, Dearnaley DP, Dwyer J, Green C, Jovic G, Ritchie AW, Russell JM, Sanders K, Thalmann G, James ND. Flexible trial design in practice - stopping arms for lack-of-benefit and adding research arms mid-trial in STAMPEDE: a multi-arm multi-stage randomized controlled trial. Trials. 2012 Sep 15;13:168. doi: 10.1186/1745-6215-13-168.
Tator CH. Spine-spinal cord relationships in spinal cord trauma. Clin Neurosurg. 1983;30:479-94. doi: 10.1093/neurosurgery/30.cn_suppl_1.479. No abstract available.
Tator CH, Fehlings MG. Review of the secondary injury theory of acute spinal cord trauma with emphasis on vascular mechanisms. J Neurosurg. 1991 Jul;75(1):15-26. doi: 10.3171/jns.1991.75.1.0015.
Walters BC. Methodology of the Guidelines for the Management of Acute Cervical Spine and Spinal Cord Injuries. Neurosurgery. 2013 Mar;72 Suppl 2:17-21. doi: 10.1227/NEU.0b013e318276ed9a. No abstract available.
Walters BC, Hadley MN, Hurlbert RJ, Aarabi B, Dhall SS, Gelb DE, Harrigan MR, Rozelle CJ, Ryken TC, Theodore N; American Association of Neurological Surgeons; Congress of Neurological Surgeons. Guidelines for the management of acute cervical spine and spinal cord injuries: 2013 update. Neurosurgery. 2013 Aug;60(CN_suppl_1):82-91. doi: 10.1227/01.neu.0000430319.32247.7f. No abstract available.
Other Identifiers
Review additional registry numbers or institutional identifiers associated with this trial.
PHX 14BN084
Identifier Type: -
Identifier Source: org_study_id
More Related Trials
Additional clinical trials that may be relevant based on similarity analysis.