Study protocol for an observational study of cerebrospinal fluid pressure in patients with degenerative cervical myelopathy undergoing surgical deCOMPression of the spinal CORD: the COMP-CORD study

Abstract

IntroductionDegenerative cervical myelopathy (DCM) is a disabling spinal disorder characterised by sensorimotor deficits of upper and lower limbs, neurogenic bladder dysfunction and neuropathic pain. When suspected, cervical MRI helps to reveal spinal cord compression and rules out alternative diagnoses. However, the correlation between radiological findings and symptoms is weak. Cerebrospinal fluid pressure (CSFP) analysis may complement the appreciation of cord compression and be used for intraoperative and postoperative monitorings in patients undergoing surgical decompression.Methods and analysisTwenty patients diagnosed with DCM undergoing surgical decompression will receive standardised lumbar CSFP monitoring immediately before, during and 24 hours after operation. Rest (ie, opening pressure, CSF pulsation) and stimulated (ie, Valsalva, Queckenstedt’s) CSFP—findings in DCM will be compared with 20 controls and results from CSFP monitoring will be related to clinical and neurophysiological findings. Arterial blood pressure will be recorded perioperatively and postoperatively to calculate spinal cord perfusion pressure and spinal vascular reactivity index. Furthermore, measures of CSFP will be compared with markers of spinal cord compression by means of MR imaging.Ethics and disseminationThe study protocol conformed to the latest revision of the Declaration of Helsinki and was approved by the local Ethics Committee of the University Hospital of Zurich (KEK-ZH number PB-2016-00623). The main publications from this study will cover the CSFP fluid dynamics and pressure analysis preoperative, perioperative and postoperative correlated with imaging, clinical scores and neurophysiology. Other publications will deal with preoperative and postoperative spinal perfusion. Furthermore, we will disseminate an analysis on waveform morphology and the correlation with blood pressure and ECG. Parts of the data will be used for computational modelling of cervical stenosis.Trial registration numberClinicalTrials.gov Registry (NCT02170155).

Medical Communication Services after Traumatic Spinal Cord Injury

“…Increased SCPP seems to be linked with enhanced neurological recovery, although monitoring spinal cord perfusion via the MAP's effect on neurological recovery after acute traumatic spinal cord injury is uncertain [ 57 ]. Maintaining MAP above 85 mm Hg can improve cord perfusion [ 7 , 28 , 58 ]. However, the relationship between rising motor evoked potential (MEP) and increasing SCPP estimates the damage of the corticospinal tract and predicts function recovery [ 26 ].…”

A New Framework for Investigating the Biological Basis of Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 5]: Mechanical Stress, Vulnerability and Time

“…96 - 98 The measurement of CSF pressure in DCM, and its response to dynamic manipulation (e.g., head inclination or reclination) is the subject of an ongoing observational study [NCT04345822]. 99 …”

“… 170 A prospective observational study of cord perfusion, in patients undergoing surgery for DCM is currently underway [NCT04345822]. 99 …”

Cerebrospinal Fluid Pressure Dynamics as a Bedside Test in Traumatic Spinal Cord Injury to Assess Surgical Spinal Cord Decompression: Safety, Feasibility, and Proof-of-Concept

“…Measurements were part of a comprehensive study that investigates CSFP dynamics in patients with spinal cord compression (NCT02170155). 17 CSFP recordings were performed before intrathecal drug administration as part of the Nogo Inhibition in Spinal Cord Injury (NISCI) study (NCT03935321) (ID1-3,6), in patients with cord compression of unclear significance prior to computer tomography (CT-) myelography (ID4,7,8-11), or during baclofen testing (ID5). Follow-up measurements were available from NISCI patients during repetitive intrathecal drug administration.…”