1
|
Timmermans M, Massalimova A, Li R, Davoodi A, Goossens Q, Niu K, Vander Poorten E, Fürnstahl P, Denis K. State-of-the-Art of Non-Radiative, Non-Visual Spine Sensing with a Focus on Sensing Forces, Vibrations and Bioelectrical Properties: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2023; 23:8094. [PMID: 37836924 PMCID: PMC10574884 DOI: 10.3390/s23198094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/04/2023] [Accepted: 09/11/2023] [Indexed: 10/15/2023]
Abstract
In the research field of robotic spine surgery, there is a big upcoming momentum for surgeon-like autonomous behaviour and surgical accuracy in robotics which goes beyond the standard engineering notions such as geometric precision. The objective of this review is to present an overview of the state of the art in non-visual, non-radiative spine sensing for the enhancement of surgical techniques in robotic automation. It provides a vantage point that facilitates experimentation and guides new research projects to what has not been investigated or integrated in surgical robotics. Studies were identified, selected and processed according to the PRISMA guidelines. Relevant study characteristics that were searched for include the sensor type and measured feature, the surgical action, the tested sample, the method for data analysis and the system's accuracy of state identification. The 6DOF f/t sensor, the microphone and the electromyography probe were the most commonly used sensors in each category, respectively. The performance of the electromyography probe is unsatisfactory in terms of preventing nerve damage as it can only signal after the nerve is disturbed. Feature thresholding and artificial neural networks were the most common decision algorithms for state identification. The fusion of different sensor data in the decision algorithm improved the accuracy of state identification.
Collapse
Affiliation(s)
- Maikel Timmermans
- KU Leuven, Department of Mechanical Engineering, BioMechanics (BMe), Smart Instrumentation, 3000 Leuven, Belgium; (Q.G.); (K.D.)
| | - Aidana Massalimova
- Research in Orthopedic Computer Science (ROCS), University Hospital Balgrist, University of Zurich, 8008 Zurich, Switzerland; (A.M.); (P.F.)
| | - Ruixuan Li
- KU Leuven, Department of Mechanical Engineering, Robot-Assisted Surgery Group (RAS), 3000 Leuven, Belgium; (R.L.); (A.D.); (K.N.); (E.V.P.)
| | - Ayoob Davoodi
- KU Leuven, Department of Mechanical Engineering, Robot-Assisted Surgery Group (RAS), 3000 Leuven, Belgium; (R.L.); (A.D.); (K.N.); (E.V.P.)
| | - Quentin Goossens
- KU Leuven, Department of Mechanical Engineering, BioMechanics (BMe), Smart Instrumentation, 3000 Leuven, Belgium; (Q.G.); (K.D.)
| | - Kenan Niu
- KU Leuven, Department of Mechanical Engineering, Robot-Assisted Surgery Group (RAS), 3000 Leuven, Belgium; (R.L.); (A.D.); (K.N.); (E.V.P.)
| | - Emmanuel Vander Poorten
- KU Leuven, Department of Mechanical Engineering, Robot-Assisted Surgery Group (RAS), 3000 Leuven, Belgium; (R.L.); (A.D.); (K.N.); (E.V.P.)
| | - Philipp Fürnstahl
- Research in Orthopedic Computer Science (ROCS), University Hospital Balgrist, University of Zurich, 8008 Zurich, Switzerland; (A.M.); (P.F.)
| | - Kathleen Denis
- KU Leuven, Department of Mechanical Engineering, BioMechanics (BMe), Smart Instrumentation, 3000 Leuven, Belgium; (Q.G.); (K.D.)
| |
Collapse
|
2
|
Sánchez Roldán MÁ, Moncho D, Rahnama K, Santa-Cruz D, Lainez E, Baiget D, Chocrón I, Gándara D, Bescós A, Sahuquillo J, Poca MA. Intraoperative Neurophysiological Monitoring in Syringomyelia Surgery: A Multimodal Approach. J Clin Med 2023; 12:5200. [PMID: 37629243 PMCID: PMC10455553 DOI: 10.3390/jcm12165200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/20/2023] [Accepted: 08/05/2023] [Indexed: 08/27/2023] Open
Abstract
Syringomyelia can be associated with multiple etiologies. The treatment of the underlying causes is first-line therapy; however, a direct approach to the syrinx is accepted as rescue treatment. Any direct intervention on the syrinx requires a myelotomy, posing a significant risk of iatrogenic spinal cord (SC) injury. Intraoperative neurophysiological monitoring (IONM) is crucial to detect and prevent surgically induced damage in neural SC pathways. We retrospectively reviewed the perioperative and intraoperative neurophysiological data and perioperative neurological examinations in ten cases of syringomyelia surgery. All the monitored modalities remained stable throughout the surgery in six cases, correlating with no new postoperative neurological deficits. In two patients, significant transitory attenuation, or loss of motor evoked potentials (MEPs), were observed and recovered after a corrective surgical maneuver, with no new postoperative deficits. In two cases, a significant MEP decrement was noted, which lasted until the end of the surgery and was associated with postoperative weakness. A transitory train of neurotonic electromyography (EMG) discharges was reported in one case. The surgical plan was adjusted, and the patient showed no postoperative deficits. The dorsal nerve roots were stimulated and identified in the seven cases where the myelotomy was performed via the dorsal root entry zone. Dorsal column mapping guided the myelotomy entry zone in four of the cases. In conclusion, multimodal IONM is feasible and reliable and may help prevent iatrogenic SC injury during syringomyelia surgery.
Collapse
Affiliation(s)
- M. Ángeles Sánchez Roldán
- Department of Clinical Neurophysiology, Vall d’Hebron University Hospital, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain; (D.M.); (K.R.); (D.S.-C.); (D.B.)
| | - Dulce Moncho
- Department of Clinical Neurophysiology, Vall d’Hebron University Hospital, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain; (D.M.); (K.R.); (D.S.-C.); (D.B.)
- Neurotraumatology and Neurosurgery Research Unit, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain;
| | - Kimia Rahnama
- Department of Clinical Neurophysiology, Vall d’Hebron University Hospital, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain; (D.M.); (K.R.); (D.S.-C.); (D.B.)
| | - Daniela Santa-Cruz
- Department of Clinical Neurophysiology, Vall d’Hebron University Hospital, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain; (D.M.); (K.R.); (D.S.-C.); (D.B.)
| | - Elena Lainez
- Department of Clinical Neurophysiology, Vall d’Hebron University Hospital, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain; (D.M.); (K.R.); (D.S.-C.); (D.B.)
| | - Daniel Baiget
- Department of Clinical Neurophysiology, Vall d’Hebron University Hospital, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain; (D.M.); (K.R.); (D.S.-C.); (D.B.)
| | - Ivette Chocrón
- Department of Anesthesiology, Vall d’Hebron University Hospital, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain;
| | - Darío Gándara
- Department of Neurosurgery, Vall d’Hebron University Hospital, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain; (D.G.); (A.B.)
| | - Agustín Bescós
- Department of Neurosurgery, Vall d’Hebron University Hospital, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain; (D.G.); (A.B.)
| | - Juan Sahuquillo
- Neurotraumatology and Neurosurgery Research Unit, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain;
- Department of Neurosurgery, Vall d’Hebron University Hospital, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain; (D.G.); (A.B.)
- Department of Surgery, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain
| | - María A. Poca
- Neurotraumatology and Neurosurgery Research Unit, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain;
- Department of Neurosurgery, Vall d’Hebron University Hospital, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain; (D.G.); (A.B.)
| |
Collapse
|
3
|
Skinner S, Guo L. Intraoperative neuromonitoring during surgery for lumbar stenosis. HANDBOOK OF CLINICAL NEUROLOGY 2022; 186:205-227. [PMID: 35772887 DOI: 10.1016/b978-0-12-819826-1.00005-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The indications for neuromonitoring during lumbar stenosis surgery are defined by the risks associated with patient positioning, the approach, decompression of neural elements, deformity correction, and instrument implantation. The routine use of EMG and SEP alone during lumbar stenosis surgery is no longer supported by the literature. Lateral approach neuromonitoring with EMG only is also suspect. Lumbar stenosis patients often present with multiple co-morbidities which put them at risk during routine pre-surgical positioning. Frequently encountered morbid obesity and/or diabetes mellitus may play a role in monitorable and preventable brachial plexopathy after "superman" positioning or femoral neuropathy from groin pressure after prone positioning, for example. Deformity correction in lumbar stenosis surgery often demands advanced implementation of multiple neuromonitoring modalities: EMG, SEP, and MEP. Because the bulbocavernosus reflex detects the function of the conus medullaris and sacral somato afferent/efferent fibers of the cauda equina, it may also be recorded. The recommendation to record pedicle screw thresholds has become more nuanced as surgeon dependence on 3D imaging, navigation, and robotics has increased. Neuromonitoring in lumbar stenosis surgery has been subject mainly to uncontrolled case series; prospective cohort trials are also needed.
Collapse
Affiliation(s)
- Stanley Skinner
- Department of Intraoperative Neurophysiology, Abbott Northwestern Hospital, Minneapolis, MN, United States.
| | - Lanjun Guo
- Department of Surgical Neuromonitoring, University of California San Francisco, San Francisco, CA, United States
| |
Collapse
|
4
|
Abstract
While most neurophysiologists are familiar with electromyography (EMG) for the purpose of clinical diagnostics, this technique also has a long tradition for neuro-monitoring. In short, intra-operative use of EMG can be divided into stimulated EMG on the one hand and monitoring of the free-running EMG and its spontaneous activity on the other hand. Methods for utilization of stimulated EMG are covered elsewhere in this book. This chapter focuses on the monitoring of spontaneous, or, more correctly, "surgically evoked" EMG. The history and underlying physiologic principles of intra-operative EMG are covered in this chapter as well as a detailed overview of the methodology. Building up from the basis of this background, we describe examples of how EMG can be used to help in intra-operative detection of adverse events and also in the prediction of postoperative outcomes. In the opinion of the authors, EMG should not be used as a "standalone" technique in contemporary neuro-monitoring. Most of its significant potential may be realized when it is used in a complementary way together with other modalities, mainly motor evoked potentials. Bearing this in mind, we sketch out how such a complementary setup may be used for improved neuro-monitoring.
Collapse
Affiliation(s)
- Julian Prell
- Department of Neurosurgery, University Halle-Wittenberg, Halle, Germany.
| | - Stanley Skinner
- Department of Intraoperative Neurophysiology, Abbott Northwestern Hospital, Minneapolis, MN, United States
| |
Collapse
|
5
|
Howick J, Cohen BA, McCulloch P, Thompson M, Skinner SA. Foundations for evidence-based intraoperative neurophysiological monitoring. Clin Neurophysiol 2016; 127:81-90. [DOI: 10.1016/j.clinph.2015.05.033] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 04/09/2015] [Accepted: 05/08/2015] [Indexed: 10/23/2022]
|
6
|
Rabai F, Sessions R, Seubert CN. Neurophysiological monitoring and spinal cord integrity. Best Pract Res Clin Anaesthesiol 2015; 30:53-68. [PMID: 27036603 DOI: 10.1016/j.bpa.2015.11.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 11/10/2015] [Accepted: 11/17/2015] [Indexed: 12/15/2022]
Abstract
An integral part of a major spine surgery is the intraoperative neurophysiological monitoring (IONM). By providing continuous functional assessment of specific anatomic structures, IONM allows the rapid detection of neuronal compromise and the opportunity for corrective action before an insult causes permanent neurological damage. Thus, IONM functions not just as a diagnostic tool but may also improve surgical outcomes. Effective clinical application requires a thorough understanding of the scope and limitations of IONM modalities not only by the monitoring team but also by the surgeon and anesthesiologist. Intraoperatively, collaboration and communication between monitorist, surgeon, and anesthesiologist are critical to the effectiveness of IONM. In this study, we review specific monitoring modalities, focusing on the relevant anatomy, physiology, and mechanisms of neuronal injury during major spine surgery. We discuss how these factors interact with anesthetic and surgical management. This review concludes with the current controversies surrounding the evidence in support of IONM and directions of future research.
Collapse
Affiliation(s)
- Ferenc Rabai
- Department of Anesthesiology, University of Florida College of Medicine, PO Box 100254 JHMHSC, 1600 SW Archer Rd., Room M-509, Gainesville, FL 32610-0254, USA.
| | - Renard Sessions
- Department of Anesthesiology, University of Florida College of Medicine, PO Box 100254 JHMHSC, 1600 SW Archer Rd., Room M-509, Gainesville, FL 32610-0254, USA.
| | - Christoph N Seubert
- Department of Anesthesiology, University of Florida College of Medicine, PO Box 100254 JHMHSC, 1600 SW Archer Rd., Room M-509, Gainesville, FL 32610-0254, USA.
| |
Collapse
|
7
|
Holdefer RN, McAuliffe J, Seubert CN, MacDonald DB, Shils JL, Edwards ME, Cohen BA, Sturm PF. Intraoperative neuromonitoring for the prevention of iatrogenic injury during cervical and thoracic spine surgery. Hippokratia 2015. [DOI: 10.1002/14651858.cd011835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Robert N Holdefer
- University of Washington School of Medicine; Department of Rehabilitation; Box 359740 Seattle WA USA 98104-2499
| | - John McAuliffe
- Cincinnati Children's Hospital Medical Center; Department of Anesthesiology; 3333 Burnet Avenue E3-238 Cincinnati Ohio USA 45229-3039
| | - Christoph N Seubert
- University of Florida College of Medicine; Director, Intraoperative Neurologic Monitoring Laboratory, Shands at UF; Gainesville FL USA
| | - David B MacDonald
- King Faisal Specialist Hospital & Research Center; Department of Neurosciences; MBC 76, PO Box 3354 Riyadh Saudi Arabia 11211
| | - Jay L Shils
- Rush University Medical Center; Department of Anesthesiology; 1750 W. Harrison (Suite 739 jelke) Chicago IL USA 60612
| | - Mary E Edwards
- University of Florida; University of Florida Health Science Center Libraries; 1600 SW Archer Road PO Box 100206 Gainesville Florida USA 32610-0206
| | - Bernard A Cohen
- Neurological Monitoring Associates, LLC; 333 West Brown Deer Road Suite 240 Milwaukee WI USA 53217
| | - Peter F Sturm
- Cincinnati Children's Hospital Medical Center; 3333 Burnet Avenue ML2017 Cincinnati OH USA 45229
| |
Collapse
|
8
|
Somatosensory and motor evoked potentials as biomarkers for post-operative neurological status. Clin Neurophysiol 2015; 126:857-65. [DOI: 10.1016/j.clinph.2014.11.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 11/07/2014] [Accepted: 11/12/2014] [Indexed: 11/22/2022]
|
9
|
Abstract
: The bulbocavernosus reflex (BCR) is mediated by the sacral somatic afferent/efferent periphery as well as the sacral cord. Unfortunately, the reflex has suffered from a partly deserved reputation as difficult to implement. However, recent stratagems have improved the test's reliability. Multipulse stimulation (enhanced by double trains as required) and exacting recording technique can yield positive and remarkably reproducible results in patients of all ages and either sex. In this review, we document a 94% baseline BCR acquisition rate among 100 consecutive cases in one institution. Acceptance and routine use of the BCR is needed to help assure optimal post-operative low sacral function in intradural and extradural surgeries at the level of conus medullaris, cauda equina, sacral plexus, and the pudendal nerve. Case studies within this review illustrate the power of the BCR to predict patient outcome or, much more importantly, reverse incipient patient injury in real time.
Collapse
|
10
|
|
11
|
Busso VO, McAuliffe JJ. Intraoperative neurophysiological monitoring in pediatric neurosurgery. Paediatr Anaesth 2014; 24:690-7. [PMID: 24853253 DOI: 10.1111/pan.12431] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/10/2014] [Indexed: 11/30/2022]
Abstract
The use of intraoperative neurophysiological monitoring (IONM) in pediatric neurosurgery is not new; however, its application to a wider range of procedures is a relatively new development. The purpose of this article is to review the physiology underlying the commonly employed IONM modalities and to describe their application to a subset of pediatric neurosurgical procedures.
Collapse
Affiliation(s)
- Veronica O Busso
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | |
Collapse
|
12
|
|
13
|
Macdonald DB, Skinner S, Shils J, Yingling C. Intraoperative motor evoked potential monitoring - a position statement by the American Society of Neurophysiological Monitoring. Clin Neurophysiol 2013; 124:2291-316. [PMID: 24055297 DOI: 10.1016/j.clinph.2013.07.025] [Citation(s) in RCA: 302] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Revised: 07/20/2013] [Accepted: 07/22/2013] [Indexed: 12/12/2022]
Abstract
The following intraoperative MEP recommendations can be made on the basis of current evidence and expert opinion: (1) Acquisition and interpretation should be done by qualified personnel. (2) The methods are sufficiently safe using appropriate precautions. (3) MEPs are an established practice option for cortical and subcortical mapping and for monitoring during surgeries risking motor injury in the brain, brainstem, spinal cord or facial nerve. (4) Intravenous anesthesia usually consisting of propofol and opioid is optimal for muscle MEPs. (5) Interpretation should consider limitations and confounding factors. (6) D-wave warning criteria consider amplitude reduction having no confounding factor explanation: >50% for intramedullary spinal cord tumor surgery, and >30-40% for peri-Rolandic surgery. (7) Muscle MEP warning criteria are tailored to the type of surgery and based on deterioration clearly exceeding variability with no confounding factor explanation. Disappearance is always a major criterion. Marked amplitude reduction, acute threshold elevation or morphology simplification could be additional minor or moderate spinal cord monitoring criteria depending on the type of surgery and the program's technique and experience. Major criteria for supratentorial, brainstem or facial nerve monitoring include >50% amplitude reduction when warranted by sufficient preceding response stability. Future advances could modify these recommendations.
Collapse
Affiliation(s)
- D B Macdonald
- Section of Clinical Neurophysiology, Department of Neurosciences, King Faisal Specialist Hospital & Research Center, MBC 76, PO Box 3354, Riyadh, Saudi Arabia.
| | | | | | | | | |
Collapse
|
14
|
Lee JHT, Jones CF, Okon EB, Anderson L, Tigchelaar S, Kooner P, Godbey T, Chua B, Gray G, Hildebrandt R, Cripton P, Tetzlaff W, Kwon BK. A novel porcine model of traumatic thoracic spinal cord injury. J Neurotrauma 2013; 30:142-59. [PMID: 23316955 DOI: 10.1089/neu.2012.2386] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Spinal cord injury (SCI) researchers have predominately utilized rodents and mice for in vivo SCI modeling and experimentation. From these small animal models have come many insights into the biology of SCI, and a growing number of novel treatments that promote behavioral recovery. It has, however, been difficult to demonstrate the efficacy of such treatments in human clinical trials. A large animal SCI model that is an intermediary between rodent and human SCI may be a valuable translational research resource for pre-clinically evaluating novel therapies, prior to embarking upon lengthy and expensive clinical trials. Here, we describe the development of such a large animal model. A thoracic spinal cord injury at T10/11 was induced in Yucatan miniature pigs (20-25 kg) using a weight drop device. Varying degrees of injury severity were induced by altering the height of the weight drop (5, 10, 20, 30, 40, and 50 cm). Behavioral recovery over 12 weeks was measured using a newly developed Porcine Thoracic Injury Behavior Scale (PTIBS). This scale distinguished locomotor recovery among animals of different injury severities, with strong intra-observer and inter-observer reliability. Histological analysis of the spinal cords 12 weeks post-injury revealed that animals with the more biomechanically severe injuries had less spared white matter and gray matter and less neurofilament immunoreactivity. Additionally, the PTIBS scores correlated strongly with the extent of tissue sparing through the epicenter of injury. This large animal model of SCI may represent a useful intermediary in the testing of novel pharmacological treatments and cell transplantation strategies.
Collapse
Affiliation(s)
- Jae H T Lee
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Spinal cord injury from electrocautery: observations in a porcine model using electromyography and motor evoked potentials. J Clin Monit Comput 2012. [DOI: 10.1007/s10877-012-9417-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
16
|
Jones CF, Lee JHT, Kwon BK, Cripton PA. Development of a large-animal model to measure dynamic cerebrospinal fluid pressure during spinal cord injury. J Neurosurg Spine 2012; 16:624-35. [DOI: 10.3171/2012.3.spine11970] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Spinal cord injury (SCI) often results in considerable permanent neurological impairment, and unfortunately, the successful translation of effective treatments from laboratory models to human patients is lacking. This may be partially attributed to differences in anatomy, physiology, and scale between humans and rodent models. One potentially important difference between the rodent and human spinal cord is the presence of a significant CSF volume within the intrathecal space around the human cord. While the CSF may “cushion” the spinal cord, pressure waves within the CSF at the time of injury may contribute to the extent and severity of the primary injury. The objective of this study was to develop a model of contusion SCI in a miniature pig and establish the feasibility of measuring spinal CSF pressure during injury.
Methods
A custom weight-drop device was used to apply thoracic contusion SCI to 17 Yucatan miniature pigs. Impact load and velocity were measured. Using fiber optic pressure transducers implanted in the thecal sac, CSF pressures resulting from 2 injury severities (caused by 50-g and 100-g weights released from a 50-cm height) were measured.
Results
The median peak impact loads were 54 N and 132 N for the 50-g and 100-g injuries, respectively. At a nominal 100 mm from the injury epicenter, the authors observed a small negative pressure peak (median −4.6 mm Hg [cranial] and −5.8 mm Hg [caudal] for 50 g; −27.6 mm Hg [cranial] and −27.2 mm Hg [caudal] for 100 g) followed by a larger positive pressure peak (median 110.5 mm Hg [cranial] and 77.1 mm Hg [caudal] for 50 g; 88.4 mm Hg [cranial] and 67.2 mm Hg [caudal] for 100 g) relative to the preinjury pressure. There were no significant differences in peak pressure between the 2 injury severities or the caudal and cranial transducer locations.
Conclusions
A new model of contusion SCI was developed to measure spinal CSF pressures during the SCI event. The results suggest that the Yucatan miniature pig is an appropriate model for studying CSF, spinal cord, and dura interactions during injury. With further development and characterization it may be an appropriate in vivo largeanimal model of SCI to answer questions regarding pathological changes, therapeutic safety, or treatment efficacy, particularly where humanlike dimensions and physiology are important.
Collapse
Affiliation(s)
- Claire F. Jones
- 1Orthopaedic and Injury Biomechanics Laboratory, Departments of Mechanical Engineering and Orthopaedics,
- 2International Collaboration on Repair Discoveries, and
| | - Jae H. T. Lee
- 2International Collaboration on Repair Discoveries, and
| | - Brian K. Kwon
- 2International Collaboration on Repair Discoveries, and
- 3Combined Neurosurgical and Orthopaedic Spine Program, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter A. Cripton
- 1Orthopaedic and Injury Biomechanics Laboratory, Departments of Mechanical Engineering and Orthopaedics,
- 2International Collaboration on Repair Discoveries, and
| |
Collapse
|
17
|
Utility of Motor Evoked Potentials for Intraoperative Nerve Root Monitoring. J Clin Neurophysiol 2012; 29:118-25. [DOI: 10.1097/wnp.0b013e31824ceeaf] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
18
|
Utility of Electromyography for Nerve Root Monitoring During Spinal Surgery. J Clin Neurophysiol 2012; 29:140-8. [DOI: 10.1097/wnp.0b013e31824cece6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
19
|
Sala F. Improving spinal cord monitoring: A neurosurgeon’s view. Clin Neurophysiol 2009; 120:649-50. [DOI: 10.1016/j.clinph.2009.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2009] [Revised: 01/15/2009] [Accepted: 01/17/2009] [Indexed: 10/21/2022]
|