PDF herunterladen
CC BY-NC-ND 4.0 · Asian J Neurosurg
DOI: 10.1055/s-0045-1808234
Review Article

The Role of Hypertonic Saline in the Management of Acute Traumatic Spinal Cord Injury: A Narrative Review of the Literature

Syed Faisal Nadeem 
1   Section of Neurosurgery, Department of Surgery, Aga Khan University, Karachi, Pakistan
,
Ahmad Hassan
1   Section of Neurosurgery, Department of Surgery, Aga Khan University, Karachi, Pakistan
,
Tabinda Tahir
1   Section of Neurosurgery, Department of Surgery, Aga Khan University, Karachi, Pakistan
,
Luis E. Carelli
2   National Institute of Traumatology and Orthopaedics, INTO Spine Institute of Rio de Janeiro, INCOL, Rio de Janeiro, Brazil
,
Andres M. Rubiano
3   Department of Neurosciences and Neurosurgery, Universidad El Bosque, Bogota, Colombia
4   Department of Surgery, Meditech Foundation, Cali, Colombia
,
Ahsan Ali Khan
1   Section of Neurosurgery, Department of Surgery, Aga Khan University, Karachi, Pakistan
› Institutsangaben Funding None.
› Weitere Informationen
Auch verfügbar auf
   Lizenzen und Reprints

Abstract

Traumatic spinal cord injury (TSCI) is a prevalent condition associated with high morbidity and mortality. The pathophysiology of TSCI involves primary injury from the traumatic insult itself and secondary injury (SI) from maladaptive biological processes that serve to aggravate the original insult, such as edema and inflammation, which exacerbate the primary injury and prevent healing and recovery. Research is currently underway to derive therapies to reduce SI-mediated damage. Hypertonic saline (HTS) has emerged as one such therapy. We conducted a literature search for animal and human studies investigating the role of HTS in TSCI on PubMed. Murine studies have shown it to possess antiedema, anti-inflammatory, and vasodilatory properties, which aid in reducing SI and thus improving functional outcomes. Combining HTS with other drugs such as procoagulants, methylprednisolone, and nitroprusside has also been shown to possess greater therapeutic benefit in rodent models of TSCI compared with single therapy with HTS. No human studies have been done till now to assess the benefits of HTS in improving human TSCI outcomes. Future research must focus on determining specific dosing and frequency regimens for HTS in human TSCI patients and on elucidating the extent of benefit it provides to them in improving their outcomes.

Keywords

hypertonic - traumatic - spine - injury - outcome

Authors' Contributions

S.F.N. developed the search string, conducted the literature search, screened the relevant articles, and wrote the final manuscript. A.H. and T.T. were responsible for extracting data and relevant information from the selected articles and also contributed to writing the final manuscript. L.E.C. and A.R. proofread the manuscript to ensure both factual accuracy and linguistic correctness. A.A.K. conceived the research question and provided critical revisions to the final manuscript.




Publikationsverlauf

Artikel online veröffentlicht:
19. Mai 2025

© 2025. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Fields JD, Bhardwaj A. Antiedema effects of hypertonic saline after spinal cord injury. Crit Care Med 2009; 37 (07) 2306-2307
    PubMedSuche in Google Scholar
  • 2 Sezer N, Akkuş S, Uğurlu FG. Chronic complications of spinal cord injury. World J Orthop 2015; 6 (01) 24-33
    CrossrefPubMedSuche in Google Scholar
  • 3 Alizadeh A, Dyck SM, Karimi-Abdolrezaee S. Traumatic spinal cord injury: an overview of pathophysiology, models and acute injury mechanisms. Front Neurol 2019; 10: 282
    CrossrefPubMedSuche in Google Scholar
  • 4 Anjum A, Yazid MD, Fauzi Daud M. et al. Spinal cord injury: pathophysiology, multimolecular interactions, and underlying recovery mechanisms. Int J Mol Sci 2020; 21 (20) 7533
    PubMedSuche in Google Scholar
  • 5 Boutonnet M, Laemmel E, Vicaut E, Duranteau J, Soubeyrand M. Combinatorial therapy with two pro-coagulants and one osmotic agent reduces the extent of the lesion in the acute phase of spinal cord injury in the rat. Intensive Care Med Exp 2017; 5 (01) 51
    PubMedSuche in Google Scholar
  • 6 Oyinbo CA. Secondary injury mechanisms in traumatic spinal cord injury: a nugget of this multiply cascade. Acta Neurobiol Exp (Warsz) 2011; 71 (02) 281-299
    CrossrefPubMedSuche in Google Scholar
  • 7 Yang CH, Quan ZX, Wang GJ. et al. Elevated intraspinal pressure in traumatic spinal cord injury is a promising therapeutic target. Neural Regen Res 2022; 17 (08) 1703-1710
    PubMedSuche in Google Scholar
  • 8 Spera PA, Arfors KE, Vasthare US, Tuma RF, Young WF. Effect of hypertonic saline on leukocyte activity after spinal cord injury. Spine 1998; 23 (22) 2444-2448 , discussion 2448–2449
    PubMedSuche in Google Scholar
  • 9 Levene HB, Elliott MB, Gaughan JP, Loftus CM, Tuma RF, Jallo JI. A murine model of hypertonic saline as a treatment for acute spinal cord injury: effects on autonomic outcome. J Neurosurg Spine 2011; 14 (01) 131-138
    PubMedSuche in Google Scholar
  • 10 Nout YS, Mihai G, Tovar CA, Schmalbrock P, Bresnahan JC, Beattie MS. Hypertonic saline attenuates cord swelling and edema in experimental spinal cord injury: a study utilizing magnetic resonance imaging. Crit Care Med 2009; 37 (07) 2160-2166
    CrossrefPubMedSuche in Google Scholar
  • 11 Young WF, Rosenwasser RH, Vasthare US, Tuma RF. Preservation of post-compression spinal cord function by infusion of hypertonic saline. J Neurosurg Anesthesiol 1994; 6 (02) 122-127
    PubMedSuche in Google Scholar
  • 12 Sumas ME, Legos JJ, Nathan D, Lamperti AA, Tuma RF, Young WF. Tonicity of resuscitative fluids influences outcome after spinal cord injury. Neurosurgery 2001; 48 (01) 167-172 , discussion 172–173
    PubMedSuche in Google Scholar
  • 13 Legos JJ, Gritman KR, Tuma RF, Young WF. Coadministration of methylprednisolone with hypertonic saline solution improves overall neurological function and survival rates in a chronic model of spinal cord injury. Neurosurgery 2001; 49 (06) 1427-1433
    PubMedSuche in Google Scholar
  • 14 de Oliveira MF, Pinto FC. Hypertonic saline: a brief overview of hemodynamic response and anti-inflammatory properties in head injury. Neural Regen Res 2015; 10 (12) 1938-1939
    PubMedSuche in Google Scholar
  • 15 Leick M, Azcutia V, Newton G, Luscinskas FW. Leukocyte recruitment in inflammation: basic concepts and new mechanistic insights based on new models and microscopic imaging technologies. Cell Tissue Res 2014; 355 (03) 647-656
    PubMedSuche in Google Scholar
  • 16 Rosengren S, Henson PM, Worthen GS. Migration-associated volume changes in neutrophils facilitate the migratory process in vitro. Am J Physiol 1994; 267 (6 Pt 1): C1623-C1632
    PubMedSuche in Google Scholar
  • 17 Spera PA, Vasthare US, Tuma RF, Young WF. The effects of hypertonic saline on spinal cord blood flow following compression injury. Acta Neurochir (Wien) 2000; 142 (07) 811-817
    PubMedSuche in Google Scholar
  • 18 Thongrong C, Kong N, Govindarajan B, Allen D, Mendel E, Bergese SD. Current purpose and practice of hypertonic saline in neurosurgery: a review of the literature. World Neurosurg 2014; 82 (06) 1307-1318
    PubMedSuche in Google Scholar