Abstract
Spinal cord ischemia can lead to paralysis or paraparesis, but if detected early it may be amenable to treatment. Current methods use evoked potentials for detection of spinal cord ischemia, a decades old technology whose warning signs are indirect and significantly delayed from the onset of ischemia. Here we introduce and demonstrate a prototype fiber optic device that directly measures spinal cord blood flow and oxygenation. This technical advance in neurological monitoring promises a new standard of care for detection of spinal cord ischemia and the opportunity for early intervention. We demonstrate the probe in an adult Dorset sheep model. Both open and percutaneous approaches were evaluated during pharmacologic, physiological, and mechanical interventions designed to induce variations in spinal cord blood flow and oxygenation. The induced variations were rapidly and reproducibly detected, demonstrating direct measurement of spinal cord ischemia in real-time. In the future, this form of hemodynamic spinal cord diagnosis could significantly improve monitoring and management in a broad range of patients, including those undergoing thoracic and abdominal aortic revascularization, spine stabilization procedures for scoliosis and trauma, spinal cord tumor resection, and those requiring management of spinal cord injury in intensive care settings.
Highlights
Spine trauma from motor vehicle accidents, falls, violence, and sports activities, occurs at rates ~60 cases per millionindividuals per year [1,2,3], and sixty-five percent of patients who present with spinal cord injury (SCI) are amenable to intervention [4]
Spinal cord injuries occur at high rates worldwide and represent a high cost for the society and the individual
In cases where patients are amenable to intervention, detection and monitoring of spinal cord hemodynamics is crucial for avoiding secondary ischemia in the intensive care unit or intraoperative setting
Summary
Spine trauma from motor vehicle accidents, falls, violence, and sports activities, occurs at rates ~60 cases per millionindividuals per year [1,2,3], and sixty-five percent of patients who present with spinal cord injury (SCI) are amenable to intervention [4]. Early surgical intervention to preserve or restore spinal cord blood flow and oxygen delivery can help prevent secondary injuries [5,6,7,8,9]. The ability to measure spinal cord blood flow with laser Doppler Flowmetry (LDF) has been demonstrated in both animal and human studies [17]. These devices, measure flow in a very limited tissue volume that is in close proximity to the probe tip; LDF sampling volumes are estimated at 0.3-0.5 mm. MRI and CT may become excellent tools for the measurement of spinal cord blood flow and can even be expected to have superior spatial sensitivity. Intra-operative monitoring with both MRI and CT is not feasible and these tools do not permit continuous monitoring
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