{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T12:54:39Z","timestamp":1791464079183,"version":"4.3.4"},"reference-count":38,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,3,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Acute traumatic spinal cord injury (tSCI) is followed by a prolonged period of secondary neuroglial cell death. Neuroprotective interventions, such as surgical spinal cord decompression, aim to mitigate secondary injury. In this study, the authors explore whether the effect size of posttraumatic neuroprotective spinal cord decompression varies with injury severity.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>Seventy-one adult female Long Evans rats were subjected to a thoracic tSCI using a third-generation spinal contusion device. Moderate and severe tSCI were defined by recorded impact force delivered to the spinal cord. Immediately after injury (&lt; 15 minutes), treatment cohorts underwent either a decompressive durotomy or myelotomy. Functional recovery was documented using the Basso, Beattie, and Bresnahan locomotor scale, and tissue sparing was documented using histological analysis.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Moderate and severe injuries were separated at a cutoff point of 231.8 kdyn peak impact force based on locomotor recovery at 8 weeks after injury. Durotomy improved hindlimb locomotor recovery 8 weeks after moderate trauma (p &lt; 0.01), but not after severe trauma (p &gt; 0.05). Myelotomy led to increased tissue sparing (p &lt; 0.0001) and a significantly higher number of spared motor neurons (p &lt; 0.05) in moderate trauma, but no such effect was noted in severely injured rats (p &gt; 0.05). Within the moderate injury group, myelotomy also resulted in significantly more spared tissue when compared with durotomy-only animals (p &lt; 0.01).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>These results suggest that the neuroprotective effects of surgical spinal cord decompression decrease with increasing injury severity in a rodent tSCI model.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2022.6.spine22383","type":"journal-article","created":{"date-parts":[[2022,12,9]],"date-time":"2022-12-09T08:17:34Z","timestamp":1670573854000},"page":"299-306","source":"Crossref","is-referenced-by-count":6,"title":["A decrease in the neuroprotective effects of acute spinal cord decompression according to injury severity: introducing the concept of a ceiling effect"],"prefix":"10.3171","volume":"38","author":[{"given":"Tobias","family":"Prasse","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, University of Washington, Seattle, Washington;"},{"name":"Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, University of Cologne; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zin Z.","family":"Khaing","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Washington, Seattle, Washington;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsay N.","family":"Cates","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Washington, Seattle, Washington;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dane M.","family":"Dewees","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Washington, Seattle, Washington;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey E.","family":"Hyde","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Washington, Seattle, Washington;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Bredow","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery, Krankenhaus Porz am Rhein, University of Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph P.","family":"Hofstetter","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Washington, Seattle, Washington;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"5","key":"b1","series-title":"Arch Phys Med Rehabil","first-page":"986","article-title":"Incidence, prevalence, costs, and impact on disability of common conditions requiring rehabilitation in the United States: stroke, spinal cord injury, traumatic brain injury, multiple sclerosis, osteoarthritis, rheumatoid arthritis, limb loss, and back pain","volume":"95","author":"Ma VY","year":"2014","unstructured":"Ma VY, Chan L, Carruthers KJ. 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Civilian gun shot wounds associated with spinal injuries. Global Spine J. 2022;12(7):1428\u20131433.33567932"},{"issue":"7","key":"b4","series-title":"Phys Ther","first-page":"673","article-title":"Vascular events after spinal cord injury: contribution to secondary pathogenesis","volume":"80","author":"Mautes AE","year":"2000","unstructured":"Mautes AE, Weinzierl MR, Donovan F, Noble LJ. Vascular events after spinal cord injury: contribution to secondary pathogenesis. Phys Ther. 2000;80(7):673\u2013687.10869130"},{"issue":"1","key":"b5","series-title":"J Neurotrauma","first-page":"38","article-title":"Mechanical properties of dura mater from the rat brain and spinal cord","volume":"25","author":"Maikos JT","year":"2008","unstructured":"Maikos JT, Elias RA, Shreiber DI. Mechanical properties of dura mater from the rat brain and spinal cord. J Neurotrauma. 2008;25(1):38\u201351.18355157"},{"issue":"12","key":"b6","series-title":"Neural Regen Res","first-page":"1953","article-title":"Repair, protection and regeneration of spinal cord injury","volume":"10","author":"Cao XJ","year":"2015","unstructured":"Cao XJ, Feng SQ, Fu CF,  Repair, protection and regeneration of spinal cord injury. Neural Regen Res. 2015;10(12):1953\u20131975."},{"issue":"3","key":"b7","series-title":"J Neurotrauma","first-page":"645","article-title":"Temporal and spatial evolution of raised intraspinal pressure after traumatic spinal cord injury","volume":"34","author":"Khaing ZZ","year":"2017","unstructured":"Khaing ZZ, Cates LN, Fischedick AE, McClintic AM, Mourad PD, Hofstetter CP. Temporal and spatial evolution of raised intraspinal pressure after traumatic spinal cord injury. J Neurotrauma. 2017;34(3):645\u2013651.27503121"},{"issue":"3","key":"b8","series-title":"Crit Care Med","first-page":"646","article-title":"Monitoring of spinal cord perfusion pressure in acute spinal cord injury: initial findings of the injured spinal cord pressure evaluation study","volume":"42","author":"Werndle MC","year":"2014","unstructured":"Werndle MC, Saadoun S, Phang I,  Monitoring of spinal cord perfusion pressure in acute spinal cord injury: initial findings of the injured spinal cord pressure evaluation study. 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Neurotherapeutics. 2011;8(2):187\u2013194."},{"issue":"2","key":"b14","series-title":"Lancet Neurol","first-page":"117","article-title":"The influence of timing of surgical decompression for acute spinal cord injury: a pooled analysis of individual patient data","volume":"20","author":"Badhiwala JH","year":"2021","unstructured":"Badhiwala JH, Wilson JR, Witiw CD,  The influence of timing of surgical decompression for acute spinal cord injury: a pooled analysis of individual patient data. Lancet Neurol. 2021;20(2):117\u2013126.33357514"},{"issue":"14","key":"b15","series-title":"Neurology","first-page":"e1257","article-title":"Progressive neurodegeneration following spinal cord injury: implications for clinical trials","volume":"90","author":"Ziegler G","year":"2018","unstructured":"Ziegler G, Grabher P, Thompson A,  Progressive neurodegeneration following spinal cord injury: implications for clinical trials. Neurology. 2018;90(14):e1257\u2013e1266.29514946"},{"issue":"17","key":"b16","series-title":"Neurology","first-page":"e1510","article-title":"Dorsal and ventral horn atrophy is associated with clinical outcome after spinal cord injury","volume":"90","author":"Huber E","year":"2018","unstructured":"Huber E, David G, Thompson AJ, Weiskopf N, Mohammadi S, Freund P. Dorsal and ventral horn atrophy is associated with clinical outcome after spinal cord injury. Neurology. 2018;90(17):e1510\u2013e1522.29592888"},{"issue":"6","key":"b17","series-title":"J Neurotrauma","first-page":"853","article-title":"Dural repair reduces connective tissue scar invasion and cystic cavity formation after acute spinal cord laceration injury in adult rats","volume":"23","author":"Iannotti C","year":"2006","unstructured":"Iannotti C, Zhang YP, Shields LB,  Dural repair reduces connective tissue scar invasion and cystic cavity formation after acute spinal cord laceration injury in adult rats. J Neurotrauma. 2006;23(6):853\u2013865.16774471"},{"issue":"5","key":"b18","series-title":"J Bone Joint Surg Am","first-page":"1206","article-title":"Role of early surgical decompression of the intradural space after cervical spinal cord injury in an animal model","volume":"92","author":"Smith JS","year":"2010","unstructured":"Smith JS, Anderson R, Pham T, Bhatia N, Steward O, Gupta R. Role of early surgical decompression of the intradural space after cervical spinal cord injury in an animal model. J Bone Joint Surg Am. 2010;92(5):1206\u20131214."},{"key":"b19","series-title":"J Orthop Surg Res","first-page":"34","article-title":"Intrathecal decompression versus epidural decompression in the treatment of severe spinal cord injury in rat model: a randomized, controlled preclinical research","volume":"11","author":"Zhang J","year":"2016","unstructured":"Zhang J, Wang H, Zhang C, Li W. Intrathecal decompression versus epidural decompression in the treatment of severe spinal cord injury in rat model: a randomized, controlled preclinical research. J Orthop Surg Res. 2016;11:34."},{"issue":"6","key":"b20","series-title":"Injury","first-page":"397","article-title":"Long-term follow-up of six patients with acute spinal injury following dural decompression","volume":"19","author":"Perkins PG","year":"1988","unstructured":"Perkins PG, Deane RH. Long-term follow-up of six patients with acute spinal injury following dural decompression. Injury. 1988;19(6):397\u2013401.3267644"},{"key":"b21","first-page":"415","article-title":"The Ohio State University ESCID spinal cord contusion model","author":"Jakeman LB","year":"2019","unstructured":"Jakeman LB, McTigue DM, Walters P, Stokes BT. The Ohio State University ESCID spinal cord contusion model. In: Chen J, Xu ZC, Xu XM, Zhang JH, eds.Animal Models of Acute Neurological Injury. Springer Series in Translational Stroke Research. Springer; 2019:415-429."},{"issue":"1","key":"b22","series-title":"J Neurotrauma","first-page":"1","article-title":"A sensitive and reliable locomotor rating scale for open field testing in rats","volume":"12","author":"Basso DM","year":"1995","unstructured":"Basso DM, Beattie MS, Bresnahan JC. A sensitive and reliable locomotor rating scale for open field testing in rats. J Neurotrauma. 1995;12(1):1\u201321.7783230"},{"issue":"1-2","key":"b23","series-title":"Biometrika","first-page":"205","article-title":"The theory of correlation between two continuous variables when one is dichotomized","volume":"42","author":"Tate RF","year":"1955","unstructured":"Tate RF. The theory of correlation between two continuous variables when one is dichotomized. 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Spinal Cord. 2007;45(3):190\u2013205.17179973"},{"issue":"1 suppl","key":"b35","series-title":"J Neurosurg Spine","first-page":"11","article-title":"Clinical predictors of neurological outcome, functional status, and survival after traumatic spinal cord injury: a systematic review","volume":"17","author":"Wilson JR","year":"2012","unstructured":"Wilson JR, Cadotte DW, Fehlings MG. Clinical predictors of neurological outcome, functional status, and survival after traumatic spinal cord injury: a systematic review. J Neurosurg Spine. 2012;17(1 suppl):11\u201326.22985366"},{"issue":"10","key":"b36","series-title":"Spinal Cord","first-page":"819","article-title":"Neurochemical biomarkers in spinal cord injury","volume":"57","author":"Kwon BK","year":"2019","unstructured":"Kwon BK, Bloom O, Wanner IB,  Neurochemical biomarkers in spinal cord injury. 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