Fluctuations in Spinal Cord Perfusion During Adult Spinal Deformity Correction Identify Neurologic Changes: Proof of Concept

Turner, Jay D.; Eastlack, Robert K.; Mirzadeh, Zaman; Nguyen, Stacie; Pawelek, Jeff

doi:10.1016/j.wneu.2015.08.067

Cited by 8 publications

(7 citation statements)

References 10 publications

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“…posterior or anterior column shortening to relieve tension on the spinal cord, or identify which patients may further benefit from additional adjuncts such as intraoperative dynamic spinal cord monitoring, real-time ultrasound imaging, or spinal cord perfusion monitoring [12][13][14]16,28 .…”

Section: Discussionmentioning

confidence: 99%

“…Despite multiple preventative strategies to minimize the risk of neurologic deficits associated with IONM loss 12 , IONM loss and postoperative neurologic deficits still occur 2,4 . Intraoperative diagnostic modalities used in response to IONM data loss have included dynamic ultrasound imaging, spinal cord perfusion monitoring, and spinal cord mapping [13][14][15][16] . Identifying patients preoperatively who are at high risk for developing IONM data loss can promote earlier preparation and guide management strategies to mitigate these risks during surgery 3,12 .…”

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confidence: 99%

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Prospective Validation of the Spinal Cord Shape Classification System in the Prediction of Intraoperative Neuromonitoring Data Loss

Bakhsheshian,

Lenke,

Hassan

et al. 2024

Journal of Bone and Joint Surgery

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Background: The Spinal Cord Shape Classification System (SCSCS) class has been associated with spinal cord monitoring data loss during spinal deformity surgery. The objective of the current study was to prospectively validate the SCSCS as a predictor of spinal cord monitoring data loss during spinal deformity surgery. Methods: A prospective cohort study of consecutive patients who were undergoing primary deformity surgery at a single institution from 2018 to 2023 and whose major curve was in the spinal cord region was undertaken. Spinal cord morphology at the apex of the major curve on preoperative axial T2-weighted magnetic resonance imaging was used to categorize patients into 3 spinal cord shape types based on the SCSCS. The primary outcome was intraoperative neuromonitoring (IONM) data loss related to spinal cord dysfunction. Demographics and surgical and radiographic variables were compared between patients with IONM data loss and those without loss. Predictors of IONM loss were determined using bivariate and multivariable logistic regression analyses. Results: A total of 256 patients (168 adult, 88 pediatric) were included and were separated into 3 SCSCS types: 110 (43.0%) with Type I, 105 (41.0%) with Type II, and 41 (16.0%) with Type III. IONM loss was observed in 30 (11.7%) of the 256 patients, including 7 (6.4%) of 110 with SCSCS Type I, 7 (6.7%) of 105 with Type II, and 16 (39.0%) of 41 with Type III. IONM loss was associated with SCSCS Type III, the preoperative deformity angular ratio, performance of 3-column osteotomies, greater operative time, greater transfusion volume, and greater postoperative sagittal corrections. SCSCS type was the strongest independent predictor of IONM data loss. SCSCS Type III had the greatest odds of IONM loss (odds ratio [OR] = 6.68, 95% confidence interval [CI] = 2.45 to 18.23 compared with Types I and II combined). The overall predictive performance with respect to IONM loss (area under the receiver operating characteristic curve = 0.827) was considered excellent. Conclusions: This prospective cohort study of patients undergoing spinal deformity correction confirmed that patients with a Type-III spinal cord shape had greater odds of IONM loss. Inclusion of the SCSCS in preoperative risk stratification and intraoperative management of spinal deformity corrective surgery is recommended. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Prospective Validation of the Spinal Cord Shape Classification System in the Prediction of Intraoperative Neuromonitoring Data Loss

Bakhsheshian,

Lenke,

Hassan

et al. 2024

Journal of Bone and Joint Surgery

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“…Review of the literature, the real time assessments of SCBF used for human are usually performed by laser Doppler flowmetry. [ 10 , 11 ] The laser Doppler flowmetry is a non-invasive, real time, continuous online and convenient technique that can monitor microvascular SCBF. [ 15 ] The Laser Doppler flowmetry was a measurement that monitor the blood perfusion of the organic/tissue (microcirculation) not the blood flow of the vessels.…”

Section: Discussionmentioning

confidence: 99%

“…[ 5 – 7 ] Laboratory can provide some study about the SCBF in traumatic SCI animal models, but those studies differ from iatrogenic SCI in human surgery. [ 8 , 9 ] Turner et al [ 10 ] first reported the SCBF changes in a patient received three-column osteotomy, then Gallagher et al [ 11 ] used laser speckle contrast imaging to visualize intraoperative SCBF at traumatic SCI site of patients. However, we are unaware of a study researched the SCBF in spinal deformity patient received PVCR with spinal column shortening.…”

Section: Introductionmentioning

confidence: 99%

A preliminary study of spinal cord blood flow during PVCR with spinal column shortening

Li¹,

Zhao²,

Wang³

et al. 2020

Medicine

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Posterior vertebral column resection (PVCR) was the most powerful technique for treating severe rigid spinal deformity, but it has been plagued with high neurologic deficits risk. The fluctuations of spinal cord blood flow (SCBF) play an important role in secondary spinal cord injury during deformity correction surgery. The objective of this study was to first provide the characteristic of SCBF during PVCR with spinal column shortening in severe rigid spinal deformity. Severe rigid scoliokyphosis patients received PVCR above L1 level were included in this prospective study. Patients with simple kyphosis, intraspinal pathology and any degree of neurologic deficits were excluded. The deformity correction was based on spinal column shortening over the resected gap during PVCR. Laser Doppler flowmetry was used to monitor the SCBF at different surgical stages. There were 12 severe rigid scoliokyphosis patients in the study. The baseline SCBF was 316 ± 86 perfusion unite (PU), and the SCBF decreased to 228 ± 68 PU after VCR ( P = .008). The SCBF increased to 296 ± 102 PU after the middle shortening and correction which has a 121% increased comparison to the SCBF after VCR ( P = .02). The SCBF will slightly decrease to 271 ± 65 PU at final fixation. The postoperative neural physical examination of all patients was negative, and the MEP and SSEP of all patients did not reach the alarm value during surgery. These results indicate that PVCR is accompanied by a change in SCBF, a proper spinal cord shortening can protect the SCBF and can prevent a secondary spinal cord injury during the surgery.

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“…In a recent study, Turner et al 25 evaluated spinal cord perfusion (using a laser Doppler probe fixated to the dura at the level of the pedicle subtraction osteotomy and intrathecal pressure monitoring using a lumbar drain, somatosensoryevoked potential and motor-evoked potential) during adult spinal deformity surgery as a marker for the risk of spinal cord injury. The alterations of perfusion and potentials guided the correction of the deformity.…”

Section: New Developmentsmentioning

confidence: 99%

Intraoperative Neurophysiological Monitoring for Spinal Fusion

Vasques¹,

Fonseca²

2017

Arq Bras Neurocir

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The surgical techniques of spinal fusion are frequently used in the treatment of many spine conditions. Apart from having anatomical knowledge, in order to perform those procedures safely, it is essential to utilize all the tools available to assure the appropriate positioning of the materials and avoid neural injury. The goal of this article is to review the literature on the use of intraoperative neurophysiological monitoring for spinal fusion procedures and to discuss the controversies regarding this issue.

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Fluctuations in Spinal Cord Perfusion During Adult Spinal Deformity Correction Identify Neurologic Changes: Proof of Concept

Cited by 8 publications

References 10 publications

Prospective Validation of the Spinal Cord Shape Classification System in the Prediction of Intraoperative Neuromonitoring Data Loss

Prospective Validation of the Spinal Cord Shape Classification System in the Prediction of Intraoperative Neuromonitoring Data Loss

A preliminary study of spinal cord blood flow during PVCR with spinal column shortening

Intraoperative Neurophysiological Monitoring for Spinal Fusion

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