Cervical Ventral Epidural Pressure Response to Graded Spinal Canal Compromise and Spinal Motion

Wolfla, Christopher E.; Snell, Brian E.; Honeycutt, Johnnie Harrel

doi:10.1097/01.brs.0000131442.87202.39

Cited by 8 publications

(8 citation statements)

References 14 publications

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“…Figure 3b shows the curve produced between the percentage of canal compromise (%) and the associated change in pressure. In comparison to Wolfla et al .,[8] who reported a sinusoidal increase in pressure, our measures fit a single-phase nonlinear model. This describes an immediate and rapid rise in pressure during the initial advancement of the DHS screw, with pressures showing incrementally smaller increases in pressure as the screw advanced.…”

Section: Resultssupporting

confidence: 46%

“…quantified the effects of graded ventral spinal canal compromise in the cervical spine. [8] In the static condition, this study showed a sinusoidal association between epidural pressures and percent canal compromise, whereby the pressures remained minimal until canal compromised reached about 20%, after which they increased sharply until around 70% where they leveled off again. This suggests that the viscoelastic property of a spinal cord allows it to have some compensatory capacity to prevent acute injury.…”

Section: Introductionmentioning

confidence: 78%

“…Interestingly, our results show a different pressure-to-degree of canal compromise curve in the thoracic and lumbar spine than those reported in the cervical spine. [8] The work from Wolfla et al . in the cat, showed a sinusoidal association between cervical ventral epidural pressure and canal compromise, where the spinal cord was able to compensate, with the little appreciable rise in epidural pressure, for the first 20% of canal compromise.…”

Section: Discussionmentioning

confidence: 99%

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Experimental study on pressure response to graded spinal canal compromise in an in vitro burst fracture mode

Bourget-Murray

Bassi

Frederick

et al. 2017

J Craniovert Jun Spine

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Background:Spinal cord compression is a known cause of spinal cord injury. The purpose of this study is to measure pressure response during graded spinal cord compression. This information will be important in evaluating the amount of canal compromise that can be tolerated before risking neurological injury secondary to cord compression. To date, there is no published study that has evaluated pressure response to graded canal compromise in the thoracic and lumbar spine.Materials and Methods:A comparative biomechanical investigation using an in vitro burst fracture model of graded spinal canal compromise was performed. Four porcine spines, sectioned into four thoracics and four lumbar segments, were harvested from 30 kg pigs. Graded spinal canal compromise (0.75 mm/30 s) was achieved using a modified 12.7 mm dynamic hip screw. The real-time ventral epidural pressure was measured at each 0.75 mm of canal compromise.Results:A significant increase in spinal cord pressure was recorded during graded spinal cord compression (P < 0.0001), and there were no statistical differences between the increase in pressure measured in the thoracic and lumbar spinal segments (P = 0.83). The pressure to degree of canal compromise curve exhibited an initial rapid rise in pressure followed by incrementally smaller increases in pressure as canal compromise increased.Conclusions:Spinal cord pressure increased with any degree of canal compromise, the most important rise occurring with initial compression. Future studies will evaluate the usefulness of laminectomy in vivo to completely restore ventral epidural pressure in the thoracic and lumbar spine.

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Section: Resultssupporting

confidence: 46%

Section: Introductionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Experimental study on pressure response to graded spinal canal compromise in an in vitro burst fracture mode

Bourget-Murray

Bassi

Frederick

et al. 2017

J Craniovert Jun Spine

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“…Extradural compression induces a rapid increase of epidural pressure. Wolfla et al (2004) indicated that ventral cervical epidural pressure increases sharply when an epidural mass occupies more than 20% of the cervical vertebral canal space. According to our data, we calculated that our experimental model compromised more than 40% of the vertebral canal over C3 and C4 vertebral bodies.…”

Section: Digital Subtraction Venographymentioning

confidence: 99%

Effects of artificially induced spinal cord compression on the canine cervical internal vertebral venous plexus: comparative evaluation of computed tomographic venography and digital subtraction venography

Gómez

Lanz²,

Jones³

et al. 2008

Arch. med. vet.

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Effects of artificially induced spinal cord compression on the canine cervical internal vertebral venous plexus: comparative evaluation of computed tomographic venography and digital subtraction venographyEfectos de la compresión de la médula espinal inducida artificialmente sobre el plexo venoso vertebral interno cervical en el perro: evaluación comparativa mediante venografía por tomografía computarizada y venografía por substracción digital RESUMENEl plexo venoso vertebral interno (PVVI) es una red vascular localizada a lo largo del canal vertebral. El presente estudio fue diseñado para evaluar variaciones en la morfología del PVVI cervical bajo condiciones de compresión aguda de la médula espinal en perros. Una compresión medular experimental fue inducida en once perros adultos al nivel de C3/4 utilizando una técnica modificada de catéter de angioplastia con balón. Los perros fueron evaluados antes, durante y posterior a la compresión medular utilizando para ello venografía intraósea por substracción digital (VSD) y venografía por tomografía computarizada (TC). La VSD mostró pérdida manifiesta e inmediata de opacificación del PVVI cervical en el sitio de la compresión. La venografía por TC también evidenció pérdida de llenado del PVVI cervical con medio de contraste en las áreas comprimidas por el balón de angioplastia. La VSD también mostró cambios hemodinámicos del PVVI y sus ramas colaterales durante la compresión. Durante la postcompresión las imágenes de la VSD y la venografía por TC revelaron que algunos perros presentaban pérdida de llenado con medio de contraste del PVVI cervical en el área previamente comprimida. Los resultados de este estudio muestran que la compresión medular experimental en perros induce alteraciones locales inmediatas en la morfología venosa dentro del canal vertebral afectado.

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“…These results might be indirectly supported by previous clinical and experimental studies. Wolfla et al 44 reported that spinal cord compression was observed in a laminectomy model, and there was a residual dynamic compression in the flexed positions. Ito et al 2 also presented that flexion may be a not good posture for patients with myelopathy due to cervical OPLL.…”

Section: Discussionmentioning

confidence: 99%

Increased stress and strain on the spinal cord due to ossification of the posterior longitudinal ligament in the cervical spine under flexion after laminectomy

Khuyagbaatar

Kim

Park

et al. 2017

Proc Inst Mech Eng H

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Myelopathy in the cervical spine due to cervical ossification of the posterior longitudinal ligament could be induced by static compression and/or dynamic factors. It has been suggested that dynamic factors need to be considered when planning and performing the decompression surgery on patients with the ossification of the posterior longitudinal ligament. A finite element model of the C2-C7 cervical spine in the neutral position was developed and used to generate flexion and extension of the cervical spine. The segmental ossification of the posterior longitudinal ligament on the C5 was assumed, and laminectomy was performed on C4-C6 according to a conventional surgical technique. For various occupying ratios of the ossified ligament between 20% and 60%, von-Mises stresses, maximum principal strains in the spinal cord, and cross-sectional area of the cord were investigated in the pre-operative and laminectomy models under flexion, neutral position, and extension. The results were consistent with previous experimental and computational studies in terms of stress, strain, and cross-sectional area. Flexion leads to higher stresses and strains in the cord than the neutral position and extension, even after decompression surgery. These higher stresses and strains might be generated by residual compression occurring at the segment with the ossification of the posterior longitudinal ligament. This study provides fundamental information under different neck positions regarding biomechanical characteristics of the spinal cord in cervical ossification of the posterior longitudinal ligament.

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Cervical Ventral Epidural Pressure Response to Graded Spinal Canal Compromise and Spinal Motion

Abstract: CVEP is elevated by both spinal canal compromise and spinal motion.

Cited by 8 publications

References 14 publications

Experimental study on pressure response to graded spinal canal compromise in an in vitro burst fracture mode

Experimental study on pressure response to graded spinal canal compromise in an in vitro burst fracture mode

Effects of artificially induced spinal cord compression on the canine cervical internal vertebral venous plexus: comparative evaluation of computed tomographic venography and digital subtraction venography

Increased stress and strain on the spinal cord due to ossification of the posterior longitudinal ligament in the cervical spine under flexion after laminectomy

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