Would you use a lumbar drain in a patient with spinal stroke from fibrocartilagenous embolism?

There are no clinical trials to suggest any benefit. Smaller studies - particularly case series have shown some benefit with the use of lumbar drain in the first 48 hours and keeping the pressure around 10 mmHg. These include mostly patients post a cardiovascular surgical procedure as a cause in the spinal cord. ischemia. Embolism due to fibrocartilage is relatively uncommon, and unfortunately, a lot of patients with this mechanism do not present in this acute window to assess for benefit. The purpose of a lumbar drain is to reduce CSF pressure on the capillaries to increase blood flow; however, compared to the brain, the collateral flow is limited in the spinal cord. Given the pathophysiology, theoretically it would make sense that lumbar ...

This is a very good question. In general, lumbar drains are really the only known therapy to help with spinal cord infarction outcomes. The idea being that you are improving flow to the spinal cord, which is compromised by an occluded artery. While I am not sure that there is clear data that indicates any difference in outcome between different types of clot (fibrin-rich vs. fibrocartilaginous), I would imagine that anything that helps perfuse the spinal cord will be helpful. Given that the outcomes are not always great and there are limited therapies, I would still go for a lumbar drain if there is no other contraindication.