Evidence map›Paper›PMID 41125903›Full record

ArticleNeurocritical care2026

Spinal Cord Blood Flow, Metabolism, and Neurological Outcome in Patients with Acute, Severe Traumatic Spinal Cord Injuries.

Hasan Asif, Ellaine Boseta, Argyro Zoumprouli, Marios C Papadopoulos, Samira Saadoun

Abstract read
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In one paragraph

Article in Neurocritical care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Hasan AsifAcademic Neurosurgery Unit, Neuroscience and Cell Biology Research Institute, City St George's, University of London, London, UK.
Ellaine BosetaAcademic Neurosurgery Unit, Neuroscience and Cell Biology Research Institute, City St George's, University of London, London, UK.
Argyro ZoumprouliNeuro-Intensive Care Unit, St George's Hospital NHS Foundation Trust, London, UK.
Marios C PapadopoulosAcademic Neurosurgery Unit, Neuroscience and Cell Biology Research Institute, City St George's, University of London, London, UK.
Samira SaadounAcademic Neurosurgery Unit, Neuroscience and Cell Biology Research Institute, City St George's, University of London, London, UK. ssaadoun@sgul.ac.uk.ORCID 0000-0002-5480-5678

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundWe characterized, in patients with severe acute traumatic spinal cord injuries, the relationships between intraoperative spinal cord blood flow (SCBF) and postoperative injury-site metabolism and physiology, preoperative magnetic resonance imaging (MRI) features, and neurological outcome.

methodsTwenty-six adults with severe, acute traumatic spinal cord injuries (American Spinal Injury Association Impairment Scale, grades A-C) had surgery within 72 h of injury. All had preoperative spine MRI and intraoperative laser speckle contrast imaging of SCBF. For four days after operation, we monitored from the injury site, intraspinal pressure (ISP), and spinal cord perfusion pressure (SCPP) as well as tissue metabolism with surface microdialysis.

resultsWe observed three intraoperative SCBF patterns: necrosis-penumbra SCBF (SCBF-necr) in 34.6% of patients, patchy-perfusion SCBF (SCBF-patchy) in 38.5% of patients, and hyperperfusion SCBF (SCBF-hyper) in 26.9% of patients. On preoperative MRI, SCBF-necr was associated with higher Brain and Spinal Injury Center MRI score versus SCBF-patchy or SCBF-hyper (median 4 vs. 2 or 2.5). SCBF-necr was associated with higher postoperative ISP, lower postoperative SCPP, and more deranged postoperative injury-site metabolism (lower glucose; higher lactate, glutamate, and glycerol) than SCBF-patchy or SCBF-hyper, with little difference between SCBF-patchy and SCBF-hyper. Machine learning analysis of physiological-metabolic data considered as seven-dimensional vectors (ISP, SCPP, glucose, pyruvate, lactate, glutamate, and glycerol) accurately distinguished between the three SCBF patterns with an area under the curve of 0.85-0.95. The seven-dimensional physiological-metabolic vectors were segregated as SCBF-necr, SCBF-patchy, and SCBF-hyper in Kohonen self-organizing maps. SCBF-patchy was associated with greater improvement in motor score than SCBF-necr or SCBF-hyper (35.3 vs. 5.2 or 2.2), independent of admission American Spinal Injury Association Impairment Scale grade.

conclusionsOur findings challenge the prevailing concept in the field, derived from animal experiments, that spinal cord injury causes necrosis at the injury site with surrounding penumbra. In humans, spinal cord injury causes three abnormal SCBF patterns detected intraoperatively, with distinct postoperative physiological-metabolic signatures, preoperative MRI characteristics, and neurological outcomes.

Indexed as

Intraoperative Neurophysiological MonitoringRegional Blood FlowSpinal CordSpinal Cord InjuriesAdultAgedFemaleHumansLactic AcidMagnetic Resonance ImagingMaleMicrodialysisMiddle AgedYoung AdultLactic AcidBlood flowMonitoringPressureProbeSelf-organizing mapsSpinal cord injury

Identifiers

PMID41125903

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.