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Kerensky MJ, Paul A, Routkevitch D, Hersh AM, Kempski Leadingham KM, Davidar AD, Judy BF, Punnoose J, Williams A, Kumar A, Lehner K, Smith B, Son JK, Azadi JR, Shekhar H, Mercado-Shekhar KP, Thakor NV, Theodore N, Manbachi A. Tethered spinal cord tension assessed via ultrasound elastography in computational and intraoperative human studies. COMMUNICATIONS MEDICINE 2024; 4:4. [PMID: 38182729 PMCID: PMC10770351 DOI: 10.1038/s43856-023-00430-6] [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: 05/05/2023] [Accepted: 12/19/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Tension in the spinal cord is a trademark of tethered cord syndrome. Unfortunately, existing tests cannot quantify tension across the bulk of the cord, making the diagnostic evaluation of stretch ambiguous. A potential non-destructive metric for spinal cord tension is ultrasound-derived shear wave velocity (SWV). The velocity is sensitive to tissue elasticity and boundary conditions including strain. We use the term Ultrasound Tensography to describe the acoustic evaluation of tension with SWV. METHODS Our solution Tethered cord Assessment with Ultrasound Tensography (TAUT) was utilized in three sub-studies: finite element simulations, a cadaveric benchtop validation, and a neurosurgical case series. The simulation computed SWV for given tensile forces. The cadaveric model with induced tension validated the SWV-tension relationship. Lastly, SWV was measured intraoperatively in patients diagnosed with tethered cords who underwent treatment (spinal column shortening). The surgery alleviates tension by decreasing the vertebral column length. RESULTS Here we observe a strong linear relationship between tension and squared SWV across the preclinical sub-studies. Higher tension induces faster shear waves in the simulation (R2 = 0.984) and cadaveric (R2 = 0.951) models. The SWV decreases in all neurosurgical procedures (p < 0.001). Moreover, TAUT has a c-statistic of 0.962 (0.92-1.00), detecting all tethered cords. CONCLUSIONS This study presents a physical, clinical metric of spinal cord tension. Strong agreement among computational, cadaveric, and clinical studies demonstrates the utility of ultrasound-induced SWV for quantitative intraoperative feedback. This technology is positioned to enhance tethered cord diagnosis, treatment, and postoperative monitoring as it differentiates stretched from healthy cords.
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Affiliation(s)
- Max J Kerensky
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Abhijit Paul
- Discipline of Biological Engineering, Indian Institute of Technology Gandhinagar, Gujarat, India
| | - Denis Routkevitch
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew M Hersh
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kelley M Kempski Leadingham
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A Daniel Davidar
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Brendan F Judy
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joshua Punnoose
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Autumn Williams
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Avisha Kumar
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Kurt Lehner
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Beth Smith
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jennifer K Son
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Javad R Azadi
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Himanshu Shekhar
- Discipline of Electrical Engineering, Indian Institute of Technology Gandhinagar, Gujarat, India
| | - Karla P Mercado-Shekhar
- Discipline of Biological Engineering, Indian Institute of Technology Gandhinagar, Gujarat, India
| | - Nitish V Thakor
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nicholas Theodore
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amir Manbachi
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA.
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, USA.
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