Abstract
Spinal cord ischemia leads to iatrogenic injury in multiple surgical fields, and the ability to immediately identify onset and anatomic origin of ischemia is critical to its management. Current clinical monitoring, however, does not directly measure spinal cord blood flow, resulting in poor sensitivity/specificity, delayed alerts, and delayed intervention. We have developed an epidural device employing diffuse correlation spectroscopy (DCS) to monitor spinal cord ischemia continuously at multiple positions. We investigate the ability of this device to localize spinal cord ischemia in a porcine model and validate DCS versus Laser Doppler Flowmetry (LDF). Specifically, we demonstrate continuous (>0.1Hz) spatially resolved (3 locations) monitoring of spinal cord blood flow in a purely ischemic model with an epidural DCS probe. Changes in blood flow measured by DCS and LDF were highly correlated (r = 0.83). Spinal cord blood flow measured by DCS caudal to aortic occlusion decreased 62%. This monitor demonstrated a sensitivity of 0.87 and specificity of 0.91 for detection of a 25% decrease in flow. This technology may enable early identification and critically important localization of spinal cord ischemia.
Highlights
Paralysis and paraparesis, resulting from iatrogenic spinal cord ischemia are not infrequent complications of vascular surgery for management of aortic disease [1,2,3,4,5,6,7], spine surgery for the management of congenital and acquired spine deformity [8, 9], or spine trauma [10]
The changes in blood flow were highly correlated between the Laser Doppler Flowmetry (LDF) and proximate diffuse correlation spectroscopy (DCS) sensor (Fig 5)
Aortic occlusion was confirmed by loss of femoral artery pressure
Summary
Paralysis and paraparesis, resulting from iatrogenic spinal cord ischemia are not infrequent complications of vascular surgery for management of aortic disease [1,2,3,4,5,6,7], spine surgery for the management of congenital and acquired spine deformity [8, 9], or spine trauma [10]. The vasculature supplying the spinal cord is complex [18] and exhibits large inter-subject variability [19, 20] in both native vascular. DRB) or pending PCT/US2015/017286 (AGY, DRB) relative to DCS technologies. None of these patents are licensed or generate royalties. There is currently no license and no sales This does not alter our adherence to PLOS ONE policies on sharing data and materials
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