Study Summary

The Canadian-American Spinal Cord Perfusion Pressure and Biomarker Study (CASPER) is a multicenter study under the collaboration of the University of British Columbia and Praxis Spinal Cord Institute. Approximately 100 patients (15 at the University of California, San Francisco) with acute traumatic cervical and thoracic spinal cord injuries (SCI) and who have a lumbar intrathecal catheter inserted within 48 hours of their injury are anticipated to enroll within 24 hours of their injury.

Currently, the clinical practice guidelines for acute spinal cord injuries recommend maintaining mean arterial pressure (MAP) at 85-90 mmHg for 7 days in patients with acute traumatic SCI. Data from the past CAMPER study has indicated that the spinal cord perfusion pressure (SCPP) is more closely related to neurologic recovery than the MAP. In the CAMPER study, SCPP was calculated as the difference between MAP and the intrathecal pressure (ITP) as measured with a lumbar intrathecal catheter.

Hence, the primary research question in this study is, “Does the active management of SCPP with maintenance at ≥ 65 mmHg result in better neurologic recovery than conventional hemodynamic management which aims solely to maintain the MAP?”

The lumbar intrathecal catheter will be inserted pre-operatively for the measurement of ITP and the collection of cerebrospinal fluid (CSF) samples. SCPP will be calculated as the difference between MAP and the ITP.

There are two important distinct yet related objectives in this prospective interventional study.

1. Determine the effect of SCPP maintenance ≥ 65 mmHg in acute SCI on neurologic recovery as measured by ASIA Impairment Scale (AIS) grade conversion and motor score improvement.

2. Collect CSF and blood samples for the measurement of neurochemical biomarkers and storage for future biomarker discovery and validation studies.

Study Sites

  • University of California, San Francisco: Zuckerberg San Francisco General Hospital (United States, California)
  • University of Nebraska Medical Center (United States, Nebraska)
  • University of New Mexico Health Sciences Center (United States, New Mexico)
  • University Pittsburgh Medical Center (United States, Pennsylvania)
  • Vancouver General Hospital (Canada, British Columbia)
  • Halifax Infirmary - QEII (Canada, Nova Scotia)
  • St. Michael's Hospital (Canada, Ontario)
  • Hôpital du Sacré-Coeur de Montreal (Canada, Quebec)

What is involved? 

  • ​Access to the patient's hospilitizaiton records for the SCI visit. 
  • Intrathecal lumbar drain that will remain inserted for a maximum 7 days. 
  • CSF samples will be collected 3 times a day for the duration of drain insertion. 
  • Blood samples will be collected 3 times a day for the first 7 days of drain insertion. 
  • International Standard for Neurological Classification of Spinal Cord Injury (ISNCSCI) motor and sensory assessments conducted at key timepoints during the patient's hospital stay, 3 months, 6 months, and 12 months post-injury. 
  • Pain assessment questionnaires in hospital, 3 months, 6 months, and 12 months post-injury. 

Who can participate?

Patients who meet the following inclusion criteria are eligible for admission into the study:

  • ZSFG hospital admission less than 24 hours from time of injury
  • Lumbar intrathecal catheter insertion as part of clinical hemodynamic management and within 48 hours of injury
  • Initial blood sample collected within 24 hours of injury 
  • CSF sample collected within 48 hours of injury
  • Male or Female ≥18
  • Complete (AIS A) or incomplete (AIS B,C) acute SCI involving bony spinal levels between C0 and T12 inclusive.
  • Blunt (non-penetrating) SCI treated either surgically or non-surgically.
  • English speaking, or with a translator where available