Hypothermia and Human Spinal Cord Injury

Position Statement and Evidence Based Recommendations from the AANS/CNS Joint Section on Disorders of the Spine and the AANS/CNS Joint Section on Trauma

November, 2007

Daniel K. Resnick, Michael G. Kaiser, Michael Fehlings, Paul C. McCormick

Recommendation:
There is not enough evidence available to recommend for or against the practice of either local or systemic therapeutic hypothermia as a treatment for acute spinal cord injury. Clinicians should be aware that systemic hypothermia has been associated with medical complications in the head injured population prior to considering this treatment modality.

Background:
Induced regional and/or mild systemic hypothermia have long been regarded as potentially beneficial treatments for the treatment of spinal cord injury. A recent high profile case of a spinal cord injury in a professional football player and the publicized use of hypothermia in the lay press have raised the public awareness regarding the potential use of this modality for the management of acute spinal cord injury. In response to requests from our membership, an ad hoc committee was asked to formulate an evidence based recommendation based upon review of the current literature.

Literature Search:
A computerized search of the National Library of medicine database was performed using PubMed and the search terms "hypothermia and spinal cord injury and human." One hundred and sixty three references were obtained. The titles and abstracts of these references were then reviewed, allowing the elimination of many basic science, vascular surgical, and technical reports. Thirteen papers were identified that dealt with human traumatic spinal cord injury and therapeutic hypothermia.

Scientific Foundation:
These papers consist of case reports, very small case series, and reviews. No studies comparing outcomes of patients with spinal cord injury with or without local or regional hypothermia have been published. There are therefore no data to suggest that outcomes of patients treated with therapeutic hypothermia are improved compared to those not treated with therapeutic hypothermia. The use of local therapeutic hypothermia via cold saline epidural lavage at the time of surgery appears to be generally safe, however criteria for temperature, duration, and volume of lavage are not established.

Conclusions:
At this point in time, there is not enough evidence available to recommend for or against the practice of either local or systemic therapeutic hypothermia as a treatment for acute spinal cord injury. Clinicians should be aware that systemic hypothermia has been associated with medical complications in the head injured population prior to considering this treatment modality.

Directions for Future Research:
Prior to the adoption of hypothermia as a treatment modality for patients with spinal cord injury, controlled clinical trials must be performed.

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