Innovative Treatment Approach for Complete Cervical SCI

An Innovative Approach for Treating Complete Cervical Spinal Cord Injury_ Expansive Duraplasty

Traumatic spinal cord injuries have long been linked to a poor prognosis and little functional recovery, particularly when they affect the cervical area. But advances in neurosurgical methods are progressively changing. Expansive duraplasty is one such procedure that has demonstrated exceptional promise in enhancing neurological outcomes for individuals suffering from whole cervical spinal cord injury (SCI). Supported by new clinical data and successful patient outcomes, this surgical method is becoming acknowledged as a crucial intervention in the treatment of neurotrauma.

Expansive Duraplasty: What is it?

In order to manage swelling and relieve pressure on the injured spinal cord, a surgical treatment known as an “expansive duraplasty” involves opening and expanding the dura mater, the tough outer membrane that surrounds the spinal cord. In order to increase the subdural space, a durotomy—a surgical incision into the dura—is usually performed first, followed by the implantation of a dural graft, which can be made of synthetic or autologous material.

This method’s main objective is to lower intrathecal pressure (ITP), which tends to increase as a result of inflammation and edema following a spinal cord injury. Increased ITP causes ischaemia and worsens neurological outcomes by limiting spinal cord perfusion. Surgeons may reduce this pressure, restore blood flow, and stop additional secondary spinal cord damage by enlarging the dural sac.

Clinical Perspectives: Expansive Duraplasty Research Results

The potential advantages of expansive duraplasty are described in a compelling article titled “Expansive Duraplasty – Simple Technique with Promising Results in Complete Cervical Spinal Cord Injury” that was published in Neurology India in 2022. Two cases of total cervical SCI (American Spinal Injury Association [ASIA] Grade A) are highlighted in the paper. The patients in these cases received:

Decompression of the posterior spine
Fixation with instruments
Large-scale duraplasty
Decompression of the posterior spine

From ASIA Grade A (no sensory or motor function) to ASIA Grade D (motor function preserved below the damage level and more than half of critical muscles have muscle grade ≥3), patients in both cases demonstrated amazing neurological recovery. These results are especially significant because full cervical SCI has a historically poor prognosis.

The study highlighted the crucial role that ITP management plays in recovery after SCI and stressed that this improvement was probably caused by the reduction of spinal cord edema and an improvement of spinal cord perfusion.

The effectiveness of the procedure was further supported by a single-center retrospective analysis that included more than 100 patients and found that those who had expanding duraplasty had significantly better motor outcomes at rehabilitation discharge than those who did not.

An Actual Case: The Remarkable Recovery of Avinash Singh

One of the most remarkable examples of expansive duraplasty’s practical efficacy is the case of Mr. Avinash Singh, a 31-year-old businessman from Delhi’s Najafgarh. Singh had a terrible swimming accident in April 2025 that left him completely paralysed below the neck, a classic example of total cervical spinal cord injury.

After receiving initial care at nearby hospitals, Singh was moved to the AIIMS Trauma Centre, where he was treated by top neurosurgeon Dr. Deepak Agrawal, who is well-known for his proficiency in treating spinal trauma. Dr. Agrawal determined to do expansive duraplasty along with spinal decompression and stabilisation after evaluating the patient and finding that the cervical spinal cord was enlarged as a result of severe injury.

Singh had a remarkable surgical improvement. He was able to regain sensation and was no longer in need of ventilator support, which is an outstanding achievement considering that recovery rates from total cervical spinal cord injuries are typically less than 1%. According to statistics, 40% of patients with catastrophic cervical spinal cord injuries need permanent ventilator care, and 80% of patients remain paralysed.

“To address the spinal cord’s swelling and pressure, which is a common cause of persistent paralysis after trauma, we performed an expansive duraplasty,” Dr. Agrawal said.

The procedure, which took place on April 30, turned out to be crucial. Given the nearly zero recovery rate in these situations, Singh’s recovery of feelings and independent respiration after 12 days was a major turning point. Despite the chances against him, he started to regain movement in his limbs by the beginning of May.

Early surgical intervention and the use of expanded duraplasty to reduce spinal cord edema have been associated by Dr. Agrawal with Singh’s quick recovery.

At least 10 patients with similarly high cervical spinal cord injuries at AIIMS Trauma Centre have benefited from expansile duraplasty in recent years, exhibiting significant improvements and a successful discharge.

Expansive Duraplasty: Why Does It Work?

Targeting the secondary damage cascade that ensues after the initial spinal trauma is crucial to the effectiveness of expanding duraplasty. This is how it’s beneficial:

Lowers Intrathecal Pressure (ITP): Blood flow is hampered by elevated pressure brought on by swelling inside the constricted dural sac. This pressure is reduced by enlarging the dura.
Enhances Spinal Cord Perfusion: Neuronal survival and regeneration depend on the injured spinal cord’s blood supply being restored.
Prevents Ischaemic Injury: Prolonged compression may result in further tissue loss. Surgeons can avoid permanent harm by releasing this pressure as soon as possible.
Promotes Neural Recovery: The spinal cord environment is better suited for functional recovery once pressure is released and blood flow is restored.

Challenges and Prospects for the Future

Even though it shows promise, expanded duraplasty is still not widely used.

The Challenges are:

Surgical Expertise: Careful surgical skill and intraoperative monitoring are necessary for this surgery.
Risks of CSF Leakage and Infection: Risks like post-operative infection and cerebrospinal fluid leakage need to be carefully controlled, just like with any dural surgery.
Patient Selection: To maximise results, selecting the best patients for expanded duraplasty is essential.

These obstacles are being progressively overcome, nonetheless, by continuing research, developing technology, and expanding clinical experience. Expandable duraplasty is set to become a standard therapy for severe spinal cord injuries as additional data supports its advantages.

In conclusion

Patients with severe spinal cord injuries have hope thanks to expansive duraplasty, which is more than just a surgical advancement. With increasing proof of its effectiveness and success stories like Avinash Singh’s, this method emphasises how crucial early, forceful, and scientifically informed intervention is in the treatment of Spinal Cord Injury.

All patients with full spinal cord injury undergoing instrumentation may be eligible for durotomy and duraplasty. Our two patients showed significant improvement, though this may not be repeatable in other situations. However, to validate the perceived benefits of this novel treatment in complete SCI, multicentric randomised studies with a larger sample size would be needed.

Expansive duraplasty may soon redefine what is achievable in spinal cord injury recovery, giving patients not only survival but a genuine shot at recovery function and enhanced quality of life as neurosurgeons like Dr. Deepak Agrawal continue to push the boundaries of spinal trauma injury.

An Innovative Approach for Treating Complete Cervical Spinal Cord Injury: Expansive Duraplasty