Evaluating perfusion of thoracic spinal cord blood using CEUS during thoracic spinal stenosis decompression surgery

Wang, Jinrui; Ligang, C; Chen, Wen; Lin, Xianchao; Liang, Jiantao

doi:10.1038/sc.2014.213

Cited by 8 publications

(4 citation statements)

References 14 publications

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“…A clinical study confirmed that the CEUS-based signal of microbubbles correlates well with blood perfusion in various organs, especially for end-capillary blood 15 . A probe was used to collect and save real-time continuous and dynamic ultrasonographic videos for 1 min after initiation of the injection 16 . The probe must be perpendicular to the spinal cord and avoid touching the dural mater to prevent iatrogenic compression.…”

Section: Methodsmentioning

confidence: 99%

Increased blood flow of spinal cord lesion after decompression improves neurological recovery of degenerative cervical myelopathy: an intraoperative ultrasonography-based prospective cohort study

Chen

Lin

Zhu

et al. 2023

International Journal of Surgery

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Introduction: Surgical decompression is a highly effective therapy for degenerative cervical myelopathy (DCM), but the mechanisms of neurological recovery following decompression remain unclear. This study aimed to evaluate the spinal cord blood flow status after sufficient decompression by intraoperative contrast-enhanced ultrasonography (CEUS) and to analyze the correlation between neurological recovery and postdecompressive spinal cord blood perfusion in DCM. Materials and methods: Patients with multilevel DCM were treated by ultrasound-guided modified French-door laminoplasty using a self-developed rongeur. Neurological function was evaluated using the modified Japanese Orthopaedic Association (mJOA) score preoperatively and at 12 months postoperatively. Spinal cord compression and cervical canal enlargement before and after surgery were assessed by magnetic resonance imaging and computerized tomography. The decompression status was evaluated in real time by intraoperative ultrasonography, while the spinal cord blood flow after sufficient decompression was assessed by CEUS. Patients were categorized as favourable (≥50%) or unfavourable (<50%) recovery according to the recovery rate of the mJOA score at 12 months postoperatively. Results: Twenty-nine patients were included in the study. The mJOA scores were significantly improved in all patients from 11.2±2.1 preoperatively to 15.0±1.1 at 12 months postoperatively, with an average recovery rate of 64.9±16.2%. Computerized tomography and intraoperative ultrasonography confirmed adequate enlargement of the cervical canal and sufficient decompression of the spinal cord, respectively. CEUS revealed that patients with favourable neurological recovery had a greater increased blood flow signal in the compressive spinal cord segment after decompression. Conclusions: In DCM, intraoperative CEUS can clearly reflect spinal cord blood flow. Patients with increased blood perfusion of the spinal cord lesion immediately after surgical decompression tended to achieve greater neurological recovery.

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Section: Methodsmentioning

confidence: 99%

Increased blood flow of spinal cord lesion after decompression improves neurological recovery of degenerative cervical myelopathy: an intraoperative ultrasonography-based prospective cohort study

Chen

Lin

Zhu

et al. 2023

International Journal of Surgery

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“…What was confusing was that the muscle power of lower limbs started to get paralyzed 10 hours after operation. Though, no similar delayed paraplegia were reported before, the most likely reasons for paraplegia after TES are spinal cord injury, epidural hematoma formation, and spinal cord ischemia [16][17][18]. In operation, special attention was paid to protect spinal cord, all procedures close to it were very careful, and no injury of spinal cord was noticed, which was veri ed by the fact that neurological status immediately after operation was just as the preoperative situation, and intraoperative spinal function monitoring may help identify spinal cord injury in time [19].…”

Section: Discussionmentioning

confidence: 99%

Delayed Incomplete Paraplegia After En Bloc Spondylectomy of Thoracic Metastasis, A Case Report

Du¹,

Liu²,

Jia³

et al. 2020

Preprint

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Background: Delayed paraplegia after total en bloc spondylectomy (TES) is exceptionally rare, and from the best of our knowledge, no such cases were reported yet. Case presentation: We herein report a case of delayed paraplegia which happened after TES of a solitary thoracic metastasis from renal clear cell carcinoma. After thorough evaluation, the patient received TES to expect a long-term local control. In operation, the patient suffered a short period of low blood pressure (mean synthetic pressure ＜90mmHg) which happened during vertebral prosthesis implantation. After operation, the neurological status was just as preoperative level, however, the patient suffered incomplete paraplegia 10 hours later. His symptoms and clinical examinations were consistent with infarct of anterior spinal artery and ischemia syndrome of spinal cord. The patient was given hyperbaric oxygen therapy and rehabilitation exercises after the tragedy, and he got recovery 2 months later, and showed much better than preoperative status 12 months later. Possible reasons for the delayed paraplegia were discussed, and we carefully concluded that intraoperative hypotension and manipulation both contributed to the happening of anterior spinal artery infarction. Conclusions: Based on this case and literature review, keeping blood pressure above daily level and other precautionary measures for spinal cord ischemia were recommended.

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“…Vetrano [30] Human Multi 12 CEUS was used to visualize tumors intraoperatively during removal CEUS allowed surgeons to see perfusion and structure of tumors in real time intraoperatively.…”

Section: Della Pepa [2]mentioning

confidence: 99%

“…Despite this, there have been several studies using this imaging modalities for various other spinal cord pathologies in humans. Ling et al [30] performed a clinical study of 12 patients undergoing surgery for decompression of chronic compressive thoracic vertebrae using CEUS. The authors were looking at time-intensity curves, enhanced intensity of the image, and rise time.…”

Section: Rodent Model Studiesmentioning

confidence: 99%

Contrast enhanced ultrasound for traumatic spinal cord injury: an overview of current and future applications

Saway,

Courtney,

Barley

et al. 2024

Spinal Cord Ser Cases

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Study design Systematic review. Objective Contrast-enhanced ultrasound (CEUS) is an imaging modality that has only recently seen neurosurgical application. CEUS uses inert microbubbles to intraoperatively visualize vasculature and perfusion of the brain and spinal cord in real time. Observation and augmentation of spinal cord perfusion is vital component of the management of traumatic spinal cord injury, yet there are limited imaging modalities to evaluate spinal cord perfusion. CEUS provides an intraoperative imaging tool to evaluate spinal cord perfusion in real time. The objective of this review is to evaluate the current literature on the various applications and benefits of CEUS in traumatic spinal cord injury. Setting South Carolina, USA. Methods This review was written according to the PRISMA 2020 guidelines. Results 143 articles were found in our literature search, with 46 of them being unique. After excluding articles for relevance to CEUS and spinal cord injury, we were left with 10 papers. Studies in animal models have shown CEUS to be an effective non-invasive imaging modality that can detect perfusion changes of injured spinal cords in real time. Conclusion This imaging modality can provide object perfusion data of the nidus of injury, surrounding penumbra and healthy neural tissue in a traumatized spinal cord. Investigation in its use in humans is ongoing and remains promising to be an effective diagnostic and prognostic tool for those suffering from spinal cord injury.

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Evaluating perfusion of thoracic spinal cord blood using CEUS during thoracic spinal stenosis decompression surgery

Cited by 8 publications

References 14 publications

Increased blood flow of spinal cord lesion after decompression improves neurological recovery of degenerative cervical myelopathy: an intraoperative ultrasonography-based prospective cohort study

Increased blood flow of spinal cord lesion after decompression improves neurological recovery of degenerative cervical myelopathy: an intraoperative ultrasonography-based prospective cohort study

Delayed Incomplete Paraplegia After En Bloc Spondylectomy of Thoracic Metastasis, A Case Report

Contrast enhanced ultrasound for traumatic spinal cord injury: an overview of current and future applications

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