Faculty Book
BARTH A. GREEN, M.D.
Chairman and Clinical Program Director
Professor and Chairman, Neurological Surgery
Surgical management of spinal cord injury
Research
Interests
A major focus of my research lies in the development of methods to surgically prevent further neurological deterioration and to promote neurological recovery in the chronic spinal cord injury (SCI) patient. The two procedures that we are researching include the delayed decompression of spinal cord and nerve roots and the surgical treatment of spinal cord cysts and tethering from scar tissue. We have found that many patients suffering SCI have nervous system tissue that is viable but not functional and that relieving long-standing pressure may often provide the potential for further recovery. The “delayed decompression” procedure is performed to surgically relieve this residual pressure. All the patients participating in this program have a significant neurological deficit associated with SCI, clinical evidence of preserved neurological function distal to the site of injury, imaging evidence of residual spinal cord and nerve root compression, and are at least three months following an acute spinal cord injury.
The second group of procedures that we are evaluating is the surgical treatment of spinal cord cysts in patients who present with the syndrome of Progressive Posttraumatic Cystic Myelopathy or myelomalacia myelopathy (microcysts) i.e., progressive neurological deterioration and dysfunction associated with cyst(s) inside and/or outside the spinal cord. This surgical protocol is directed at limiting and, if possible, reversing their delayed neurological deterioration.
I am also collaborating with Drs. Robert Quencer, Blair Calancie, and Michael Norenberg on the Human Spinal Cord Injury Model project. This very important research program correlates a patient’s neurological function with their neurophysiological (electrical) status and imaging studies. In the rare cases of SCI victims who die from their injuries, or of natural causes, their histopathology, i.e., the microscopic analysis of the spinal cord tissue, is correlated as well. This important investigation offers the potential for a more realistic understanding of the injured spinal cord in humans. This will permit the development of more rational approaches to the treatment of these devastating injuries for both acute and chronic paralysis victims.
Martinez-Arizala A and Green BA (1992) Hypothermia in spinal cord injury. J Neurotrauma 9:S497-S505. [Abstract]
Green BA, David C, Falcone S, Razack N and Klose KJ (1996) Spinal cord injuries in adults. In: Neurological Surgery, 4th Edition. J Youmans, S Decker, S Dunsker et al. (eds). WB Saunders Co. Philadelphia, PA. Chap 85 pp. 1969-1990.
Green BA, Leet TT, Madsen PW and Falcone SF (1997) Management of post-traumatic cystic myelopathy. Topics Spinal Cord Inj Rehabil 2:36-46.
Lee TT and Green BA (1997) Trauma and paraplegia. In: Spinal Cord Disease: Basic Science Diagnosis. A Colborne (ed). SpringerVerlag Chap 32 pp.545-583.
Lee TT, Manzano GR and Green BA (1997) Modified open-door cervical expansive lamioplasty for spondylotic myelopathy: Operative technique, outcome and predictors for gait improvement. J Neurosurg 86:64-68.
Lee TT, Arias JM, Andrus HL, Quencer RM, Falcone SF and Green BA (1997) Progressive post-traumatic myelomalacic myelopathy: Treatment with untethering and expansive duraplasty. J Neurosurg 86:624-628. [Abstract]
Quencer RM, Nunez D and Green BA (1997) Controversies in imaging acute cervical spine trauma. Am J Neuroradiol 18:1866-1868. [Abstract]
last updated 4/16/99
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