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Mainard N, Tsiakaka O, Li S, Denoulet J, Messaoudene K, Vialle R, Feruglio S. Intraoperative Optical Monitoring of Spinal Cord Hemodynamics Using Multiwavelength Imaging System. SENSORS (BASEL, SWITZERLAND) 2022; 22:3840. [PMID: 35632249 PMCID: PMC9146887 DOI: 10.3390/s22103840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 12/10/2022]
Abstract
The spinal cord is a major structure of the central nervous system allowing, among other things, the transmission of afferent sensory and efferent motor information. During spinal surgery, such as scoliosis correction, this structure can be damaged, resulting in major neurological damage to the patient. To date, there is no direct way to monitor the oxygenation of the spinal cord intraoperatively to reflect its vitality. This is essential information that would allow surgeons to adapt their procedure in case of ischemic suffering of the spinal cord. We report the development of a specific device to monitor the functional status of biological tissues with high resolution. The device, operating with multiple wavelengths, uses Near-InfraRed Spectroscopy (NIRS) in combination with other additional sensors, including ElectroNeuroGraphy (ENG). In this paper, we focused primarily on aspects of the PhotoPlethysmoGram (PPG), emanating from four different light sources to show in real time and record biological signals from the spinal cord in transmission and reflection modes. This multispectral system was successfully tested in in vivo experiments on the spinal cord of a pig for specific medical applications.
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Affiliation(s)
- Nicolas Mainard
- Department of Pediatric Surgery, Jeanne-de-Flandre Hospital, CHU Lille, Avenue Eugène-Avinée, 59000 Lille, France
- Laboratoire D’Informatique de Paris 6 (LIP6), CNRS UMR7606, Sorbonne Université, 4 Place Jussieu, CEDEX 05, 75252 Paris, France; (S.L.); (J.D.); (K.M.); (S.F.)
| | - Olivier Tsiakaka
- CERVO, Biomedical Microsystems Laboratory, Université Laval, Quebec, QC G1V 0A6, Canada;
| | - Songlin Li
- Laboratoire D’Informatique de Paris 6 (LIP6), CNRS UMR7606, Sorbonne Université, 4 Place Jussieu, CEDEX 05, 75252 Paris, France; (S.L.); (J.D.); (K.M.); (S.F.)
| | - Julien Denoulet
- Laboratoire D’Informatique de Paris 6 (LIP6), CNRS UMR7606, Sorbonne Université, 4 Place Jussieu, CEDEX 05, 75252 Paris, France; (S.L.); (J.D.); (K.M.); (S.F.)
| | - Karim Messaoudene
- Laboratoire D’Informatique de Paris 6 (LIP6), CNRS UMR7606, Sorbonne Université, 4 Place Jussieu, CEDEX 05, 75252 Paris, France; (S.L.); (J.D.); (K.M.); (S.F.)
| | - Raphael Vialle
- Clinical Research Group “RIC” Robotics and Surgical Innovations, GRC-33 Sorbonne University, 26 Avenue du Dr. Arnold Netter, 75012 Paris, France;
| | - Sylvain Feruglio
- Laboratoire D’Informatique de Paris 6 (LIP6), CNRS UMR7606, Sorbonne Université, 4 Place Jussieu, CEDEX 05, 75252 Paris, France; (S.L.); (J.D.); (K.M.); (S.F.)
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Kish B, Herr S, Yang HCS, Sun S, Shi R, Tong Y. Whole body measurements using near-infrared spectroscopy in a rat spinal cord contusion injury model. J Spinal Cord Med 2021; 46:508-520. [PMID: 33890843 PMCID: PMC10116927 DOI: 10.1080/10790268.2021.1911504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Spinal cord injuries cause great damage to the central nervous system as well as the peripheral vasculature. While treatments for spinal cord injury typically focus on the spine itself, improvements in the function of the peripheral vasculature after spinal cord injury have shown to improve overall neurological recovery. OBJECTIVE This study focused on the use of near-infrared spectroscopy (NIRS) as a mode to monitor cerebral and peripheral vascular condition non-invasively during the recovery process. DESIGN Animal research study. METHODS Rats underwent spinal contusion or sham injury and relative concentrations of de-/oxyhemoglobin (Δ[HbO]/Δ[Hb]) over time were measured over the cerebral, spinal, and pedal regions via NIRS. Correlational relationships across the body were determined. Rats received 1 NIRS measurement before injury and 3 after injury: 4, 7, and 14 days post. RESULTS Correlational relationships between signals across the body, between animals with and without spinal cord injury, indicate that NIRS was able to detect patterns of vascular change in the spine and the periphery occurring secondary to spinal cord injury and evolving during subsequent recovery. Additionally, NIRS determined an overall correlational decrease within the central nervous system, between spinal and cerebral measurements. CONCLUSION NIRS was able to closely reflect physiologic changes in the rat during recovery, demonstrating a promising method to monitor whole body hemodynamics after spinal cord injury.
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Affiliation(s)
- Brianna Kish
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Seth Herr
- Center for Paralysis Research and Department of Basic Medical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
| | - Ho-Ching Shawn Yang
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Siyuan Sun
- Center for Paralysis Research and Department of Basic Medical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
| | - Riyi Shi
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA.,Center for Paralysis Research and Department of Basic Medical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
| | - Yunjie Tong
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA
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Kurita T, Kawashima S, Morita K, Nakajima Y. Spinal cord autoregulation using near-infrared spectroscopy under normal, hypovolemic, and post-fluid resuscitation conditions in a swine model: a comparison with cerebral autoregulation. J Intensive Care 2020; 8:27. [PMID: 32318269 PMCID: PMC7158138 DOI: 10.1186/s40560-020-00443-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 03/31/2020] [Indexed: 11/17/2022] Open
Abstract
Background Few studies have investigated spinal cord autoregulation using near-infrared spectroscopy (NIRS). Here, we assessed spinal cord autoregulation under normal, hypovolemic, and post-fluid resuscitation conditions compared with cerebral autoregulation. Methods Ten pigs (36.1 ± 1.1 kg) were anesthetized with 2.5% isoflurane, before phenylephrine administration at 0.5, 1, 2, and 5 μg kg−1 min−1 in a stepwise fashion at 10-min intervals (baseline), followed by similar administration of sodium nitroprusside (SNP). Hypovolemia was induced by a 600-ml bleed (25% estimated total blood volume). Only phenylephrine was readministered (same protocol). Hypovolemia was reversed by infusing 600 ml hydroxyethyl starch, before readministering phenylephrine and SNP. The relationships between mean arterial pressure (MAP) and cerebral, thoracic, and lumbar spinal cord tissue oxygenation indices (TOIs) were evaluated. Results Thoracic and lumbar spinal cord TOIs were approximately 15% and 10% lower, respectively, than the cerebral TOI at similar MAPs. The average relationship between MAP and each TOI showed an autoregulatory pattern, but negative correlations were observed in the cerebral TOI during phenylephrine infusion. A 600-ml bleed lowered each relationship < 5% and subsequent fluid resuscitation did not change the relationship. Individual oxygenation responses to blood pressure indicated that the spinal cord is more pressure-passive than the cerebrum. Paradoxical responses (an inverse relationship of tissue oxygenation to MAP) were observed particularly in cerebrum during phenylephrine infusion and were rare in the spinal cord. Conclusions Spinal cord autoregulation is less robust than cerebral autoregulation and more pressure-dependent. Similar to cerebral oxygenation, spinal cord oxygenation is volume-tolerant but is more sensitive to hypotension.
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Affiliation(s)
- Tadayoshi Kurita
- Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192 Japan
| | - Shingo Kawashima
- Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192 Japan
| | - Koji Morita
- Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192 Japan
| | - Yoshiki Nakajima
- Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192 Japan
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Vanpeteghem CM, Van de Moortel LMM, De Hert SG, Moerman AT. Assessment of Spinal Cord Ischemia With Near-Infrared Spectroscopy: Myth or Reality? J Cardiothorac Vasc Anesth 2019; 34:791-796. [PMID: 31399303 DOI: 10.1053/j.jvca.2019.06.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 06/21/2019] [Accepted: 06/27/2019] [Indexed: 11/11/2022]
Abstract
Non-invasive near-infrared spectroscopy is gaining popularity in the detection of spinal cord ischemia following aortic aneurysm repair. However, practical recommendations are lacking. This review focuses on the physiological and anatomical background, as well as on the clinical implementations of near-infrared spectroscopy as a tool for monitoring ischemia of the spinal cord. Clinical recommendations based on the currently available evidence are rendered.
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Affiliation(s)
- C M Vanpeteghem
- Department of Anesthesia and Perioperative Care, University Hospital Ghent, Ghent, Belgium.
| | - L M M Van de Moortel
- Department of Anesthesia and Perioperative Care, University Hospital Ghent, Ghent, Belgium
| | - S G De Hert
- Department of Anesthesia and Perioperative Care, University Hospital Ghent, Ghent, Belgium
| | - A T Moerman
- Department of Anesthesia and Perioperative Care, University Hospital Ghent, Ghent, Belgium
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Rashnavadi T, Macnab A, Cheung A, Shadgan A, Kwon BK, Shadgan B. Monitoring spinal cord hemodynamics and tissue oxygenation: a review of the literature with special focus on the near-infrared spectroscopy technique. Spinal Cord 2019; 57:617-625. [PMID: 31164734 DOI: 10.1038/s41393-019-0304-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/21/2019] [Accepted: 05/22/2019] [Indexed: 01/05/2023]
Abstract
STUDY DESIGN Review. OBJECTIVES Clinical studies have shown that the hemodynamic management of patients following acute spinal cord injury (SCI) is an important aspect of their treatment for maintaining spinal cord (SC) perfusion and minimizing ischemic secondary injury to the SC. While this highlights the importance of ensuring adequate perfusion and oxygenation to the injured cord, a method for the real-time monitoring of these hemodynamic measures within the SC is lacking. The purpose of this review is to discuss current and potential methods for SC hemodynamic monitoring with special focus on applications using near-infrared spectroscopy (NIRS). METHODS A literature search using the PubMed database. All peer-reviewed articles on NIRS monitoring of SC published from inception to May 2019 were reviewed. RESULTS Among 125 papers related to SC hemodynamics monitoring, 26 focused on direct/indirect NIRS monitoring of the SC. DISCUSSION Current options for continuous, non-invasive, and real-time monitoring of SC hemodynamics are challenging and limited in scope. As a relatively new technique, NIRS has been successfully used for monitoring human cerebral hemodynamics, and has shown promising results in intraoperative assessment of SC hemodynamics in both human and animal models. Although utilizing NIRS to monitor the SC has been validated, applying NIRS clinically following SCI requires further development and investigation. CONCLUSIONS NIRS is a promising non-invasive technique with the potential to provide real-time monitoring of relevant parameters in the SC. Currently, in its first developmental stages, further clinical and experimental studies are mandatory to ensure the validity and safety of NIRS techniques.
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Affiliation(s)
- Tahereh Rashnavadi
- The University of British Columbia, School of Biomedical Engineering, Vancouver, BC, V6T 1Z1, Canada
| | - Andrew Macnab
- International Collaborations on Repair Discoveries (ICORD), Blusson Spinal Cord Centre, Vancouver, Canada
| | - Amanda Cheung
- International Collaborations on Repair Discoveries (ICORD), Blusson Spinal Cord Centre, Vancouver, Canada
| | - Armita Shadgan
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, Canada
| | - Brian K Kwon
- International Collaborations on Repair Discoveries (ICORD), Blusson Spinal Cord Centre, Vancouver, Canada.,Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
| | - Babak Shadgan
- The University of British Columbia, School of Biomedical Engineering, Vancouver, BC, V6T 1Z1, Canada. .,International Collaborations on Repair Discoveries (ICORD), Blusson Spinal Cord Centre, Vancouver, Canada. .,Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, Vancouver, Canada.
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Suehiro K, Funao T, Fujimoto Y, Mukai A, Nakamura M, Nishikawa K. Transcutaneous near-infrared spectroscopy for monitoring spinal cord ischemia: an experimental study in swine. J Clin Monit Comput 2016; 31:975-979. [DOI: 10.1007/s10877-016-9931-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 08/24/2016] [Indexed: 11/30/2022]
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Spinal Near-Infrared Spectroscopy Measurements During and After Thoracoabdominal Aortic Aneurysm Repair: A Pilot Study. Ann Thorac Surg 2015; 99:1267-74. [DOI: 10.1016/j.athoracsur.2014.10.032] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 10/02/2014] [Accepted: 10/07/2014] [Indexed: 11/17/2022]
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Amiri AR, Lee CH, Leung TS, Hetreed M, Craggs MD, Casey ATH. Intraoperative assessment of human spinal cord perfusion using near infrared spectroscopy with indocyanine green tracer technique. Spine J 2013; 13:1818-25. [PMID: 23954558 DOI: 10.1016/j.spinee.2013.05.054] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 03/05/2013] [Accepted: 05/30/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Despite the significant interest in the assessment of human cerebral perfusion, investigations into human spinal cord perfusion (SCP) are scarce. Current intraoperative monitoring of spinal cord relies on the assessment of neural conduction as a surrogate for SCP. However, there are various inherent limitations associated with the use of these techniques. Near infrared spectroscopy (NIRS) has been successfully used for monitoring and assessment of human cerebral perfusion and has shown promising results in intraoperative assessment of SCP in animal models. PURPOSE The aim of this study was to investigate whether it is possible to monitor physiological changes in human SCP intraoperatively using NIRS with indocyanine green (ICG) tracer technique. We used this technique to calculate the human spinal cord carbon dioxide (CO₂) reactivity index. In addition, we investigated whether the lamina causes significant attenuation of NIRS signals. STUDY DESIGN/SETTING Intraoperative human experimental study. PATIENT SAMPLE Eighteen patients undergoing elective posterior cervical spine surgery. OUTCOME MEASURES Carbon dioxide reactivity of human SCP. METHODS Nine patients underwent transdural assessment of SCP, with an additional nine patients undergoing translaminar measurements. Patients' SCP was continuously monitored using an NIRO-500 NIRS monitor via a set of purpose built optodes. Their arterial ICG concentration was simultaneously assessed using a pulse dye densitometer. Patients' end-tidal CO₂ was gradually increased by 7.5 mm Hg and then returned back to baseline. Three sets of measurements were taken: baseline, hypercapnic, and return to baseline. RESULTS After hypercapnia, SCP increased by a mean of 57.2 ± 23.3% in the transdural group and 46.6 ± 36.3% in the translaminar group. Carbon dioxide reactivity index was 7.6 ± 3.2%ΔSCP/mm Hg in the transdural group and 6.4 ± 5.3 %ΔSCP/mm Hg in the translaminar group. There was no significant difference in the increase in SCP (p=.475) or the CO₂ reactivity index (p=.581) observed between the transdural and the translaminar groups. CONCLUSIONS Intraoperative NIRS with ICG tracer technique can identify an increase in the SCP in response to hypercapnia. It is possible to use this technique for monitoring SCP over the dura and the lamina. This technique could potentially be used to provide insight in to the pathophysiology and autoregulation of commonly acquired spinal cord conditions. Further research assessing the use of NIRS for monitoring of SCP is required.
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Affiliation(s)
- Amir Reza Amiri
- Spinal Injury Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, United Kingdom.
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Demir A, Erdemli Ö, Ünal U, Taşoğlu İ. Near-Infrared Spectroscopy Monitoring of the Spinal Cord During Type B Aortic Dissection Surgery. J Card Surg 2013; 28:291-4. [DOI: 10.1111/jocs.12082] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Aslı Demir
- Anesthesia Clinic; Türkiye Yüksek İhtisas Education and Research Hospital; Ankara Turkey
| | - Özcan Erdemli
- Cardiovasculary Clinic; Acıbadem University Medical Faculty Ankara Acıbadem Hospital; Ankara Turkey
| | - Utku Ünal
- Cardiovasculary Clinic; Türkiye Yüksek İhtisas Education and Research Hospital; Ankara Turkey
| | - İrfan Taşoğlu
- Cardiovasculary Clinic; Türkiye Yüksek İhtisas Education and Research Hospital; Ankara Turkey
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Chen Z, Lerman J. Protection of the remaining spinal cord function with intraoperative neurophysiological monitoring during paraparetic scoliosis surgery: a case report. J Clin Monit Comput 2011; 26:13-6. [DOI: 10.1007/s10877-011-9325-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 12/01/2011] [Indexed: 10/14/2022]
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Badner NH, Nicolaou G, Clarke CF, Forbes TL. Use of Spinal Near-Infrared Spectroscopy for Monitoring Spinal Cord Perfusion During Endovascular Thoracic Aortic Repairs. J Cardiothorac Vasc Anesth 2011; 25:316-9. [DOI: 10.1053/j.jvca.2010.01.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Indexed: 11/11/2022]
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Moerman A, Van Herzeele I, Vanpeteghem C, Vermassen F, François K, Wouters P. Near-Infrared Spectroscopy for Monitoring Spinal Cord Ischemia During Hybrid Thoracoabdominal Aortic Aneurysm Repair. J Endovasc Ther 2011; 18:91-5. [DOI: 10.1583/10-3224.1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Goguin A, Lesage F, Leblond H, Pélégrini-Issac M, Rossignol S, Benali H. A low-cost implantable near-infrared imaging system of spinal cord activity in the cat. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2010; 4:329-335. [PMID: 23853378 DOI: 10.1109/tbcas.2010.2067211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
A low-cost device using diffuse optical imaging (DOI) for measuring in vivo hemodynamic changes in the spinal cord has been developed. The proposed system is aimed at monitoring for the first time real-time hemodynamic changes associated with intraspinal rhythmic motor activity monitored by electroneurogram (ENG) evoked in paralyzed cats (fictive locomotion). The device contains the emitting and collecting probes within a saddle that fits over a vertebra and has been developed with discrete component circuits. Experiments performed in two acutely decerebrate and paralyzed cats confirm a noticeable and reproducible hemodynamic response during episodes of fictive locomotion. The device is designed so that it could be implanted chronically. In the future, a multi-implant imaging platform could measure long-term hemodynamic changes in the spinal cord.
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Abstract
STUDY DESIGN We developed a real-time, in vivo monitoring system for the evaluation of spinal cord viability in rats during spinal cord ischemia. OBJECTIVE The aim of the present study was to apply a real-time multiparametric monitoring system in a rat spinal cord model exposed to ischemia or mechanical compression. SUMMARY OF BACKGROUND DATA The evaluation of spinal cord integrity during spine surgeries is highly important, as it enhances the potential to prevent secondary irreversible damage to the spinal cord tissue. Mitochondrial NADH redox state is the most sensitive parameter for tissue oxygenation state and, together with microcirculatory blood flow, can estimate the metabolic status of the spinal cord tissue. METHODS We applied the Tissue Vitality Monitoring System (TVMS) that includes optical fibers for the simultaneous monitoring of the spinal cord blood flow (SCBF) using laser Doppler flowmetry, and the mitochondrial NADH fluorescence using the fluorometric technique. Additionally, systemic arterial blood pressure was measured. Two models involving the interruption of the spinal blood flow were tested: the occlusion of the abdominal aorta (ischemia) and spine mechanical compression. RESULTS The results clearly demonstrated the link between the level of ischemia and the viability state of the spinal tissue. When SCBF decreased, in both experimental models, mitochondrial NADH was elevated, while reperfusion was associated with NADH oxidation. Nevertheless, during the recovery phase, even though SCBF significantly increased (became hyperemic), no further oxidation of NADH was observed. CONCLUSION The monitoring of the mitochondrial function together with SCBF by the TVMS reflects the viability of the spinal cord tissue and, together with the conventional monitoring techniques, may help to evaluate the spine conditions, especially under surgical procedures involving the deterioration of the spinal cord blood supply.
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LeMaire SA, Ochoa LN, Conklin LD, Widman RA, Clubb FJ, Undar A, Schmittling ZC, Wang XL, Fraser CD, Coselli JS. Transcutaneous near-infrared spectroscopy for detection of regional spinal ischemia during intercostal artery ligation: Preliminary experimental results. J Thorac Cardiovasc Surg 2006; 132:1150-5. [PMID: 17059937 DOI: 10.1016/j.jtcvs.2006.05.047] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2006] [Revised: 04/27/2006] [Accepted: 05/08/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Real-time information about regional spinal cord ischemia can guide intraoperative management and reduce the risk of paraplegia after thoracic aortic surgery. We hypothesized that near-infrared spectroscopy could provide such information during intercostal and lumbar artery ligation in pigs. METHODS Transcutaneous near-infrared spectroscopic sensors were placed in the midline over the upper and lower thoracic vertebrae of 4 progressively larger pigs (weight range 21-70 kg). After the entire aorta was exposed, segmental arteries from T6 through L1 were sequentially ligated while regional oxygen saturation was monitored. Decreases in regional oxygen saturation were calculated as percentage changes from baseline. The degrees of ischemia in the upper and lower spinal cord were compared histopathologically. RESULTS Baseline regional oxygen saturations were similar in the upper (68.8% +/- 9.0%) and lower (68.0% +/- 11.5%, P = .82) cord. After ligation, however, regional oxygen saturation levels were significantly lower in the lower cord (41.3% +/- 10.1%) than in the upper cord (64.8% +/- 9.3%, P = .037). The regional oxygen saturation had decreased by 39.0% +/- 11.5% in the lower cord but only by 6.3% +/- 7.6% in the upper cord (P = .026). This difference was confirmed microscopically: upper-cord sections had fewer ischemic neurons (8.8 +/- 9.4) than did lower-cord sections (21.3 +/- 13.6, P = .002). CONCLUSION Intraoperative spinal cord ischemia was detectable with near-infrared spectroscopy in pigs weighing as much as 70 kg. The potential utility of this technique in patients undergoing thoracic aortic surgery warrants investigation.
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Affiliation(s)
- Scott A LeMaire
- Cardiovascular Surgery Service, Texas Heart Institute at St Luke's Episcopal Hospital, Houston, Tex, USA.
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Radhakrishnan H, Liu H, Senapati AK, Peng YB. Determination of hemoglobin oxygen saturation in rat sciatic nerve by in vivo near infrared spectroscopy. Brain Res 2006; 1098:86-93. [PMID: 16784732 DOI: 10.1016/j.brainres.2006.04.101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2005] [Revised: 04/14/2006] [Accepted: 04/23/2006] [Indexed: 11/16/2022]
Abstract
The purpose of this study is to investigate the values of hemoglobin oxygen saturation in the sciatic nerve of the rat following spinal nerve ligation. An optical spectroscopic technique along with a fiber optic probe was used to test the hypothesis that demyelination and degeneration after nerve injury lead to a significant decrease in the percentage of hemoglobin oxygen saturation. A modified spinal nerve ligation method was used to induce the degeneration, and three types of ligation on left spinal nerve (L4, L4 and L5, L5) were performed in rats. The optical reflectance measurements were taken from the left and right sciatic nerves on postoperative days 1, 4, 7, and 14. No significant difference was found among the three types of ligation, nor was between left and right sciatic nerve at postoperative day 1. Significant decreases in oxygen saturation percentages were found between left and right sciatic nerves at postoperative days 4, 7, and 14. This study continues to show the effectiveness of optical methods in determining/differentiating tissue properties, providing an excellent and robust in vivo technique that can have a potential clinical application in detecting demyelination and degeneration of the nervous system.
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Affiliation(s)
- Harsha Radhakrishnan
- University of Texas at Arlington/UT Southwestern Medical Center at Dallas, Joint Graduate Program of Biomedical Engineering, Arlington, TX 76019, USA
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Radhakrishnan H, Senapati A, Kashyap D, Peng YB, Liu H. Light scattering from rat nervous system measured intraoperatively by near-infrared reflectance spectroscopy. JOURNAL OF BIOMEDICAL OPTICS 2005; 10:051405. [PMID: 16292942 DOI: 10.1117/1.2098487] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Our goal is to quantify scattering properties of near-IR light in the rat spinal cord region and to differentiate healthy and demyelinated peripheral nerves intraoperatively based on differential light scattering. For the rat spinal cord, optical reflectance is measured from the spinal cord surface at spatial intervals of 1 mm using a needle probe. Data are acquired from left and right lumbar regions of the animals as well as on the central blood vessels. The reduced scattering coefficient mu(s)' is found to be higher (34.2+/-2.1 cm(-1)) in the lumbar regions of the spinal cord than on the central blood vessel (19.9+/-1.0 cm(-1)). This methodology is extended to detect differences in the rat sciatic nerves following left L4 spinal nerve ligation. The reflectance is taken at the same five regions at postoperative days 1, 4, 7, and 14. Significant differences are seen in both the spectral slope and mu(s)' values on postoperative days 4, 7, and 14, indicating that either of the two quantities could be used as a marker for demyelination. We prove the usefulness of the technique, which may have a possible clinical application for minimally invasive, intraoperative diagnosis and monitoring of demyelination diseases, such as multiple sclerosis in the central nervous system or degeneration of the peripheral nervous system.
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Affiliation(s)
- Harsha Radhakrishnan
- University of Texas at Arlington, University of Texas Southwestern Medical Center at Dallas, Joint Graduate Program of Biomedical Engineering, Arlington, Texas 76019, USA
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Gagnon RE, Macnab AJ, Gagnon FA, Leblanc JG. Brain, spine, and muscle cytochrome Cu-A redox patterns of change during hypothermic circulatory arrest in swine. Comp Biochem Physiol A Mol Integr Physiol 2005; 141:264-70. [PMID: 16023395 DOI: 10.1016/j.cbpb.2005.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2004] [Revised: 03/29/2005] [Accepted: 04/02/2005] [Indexed: 11/23/2022]
Abstract
Past near infrared spectroscopy (NIRS) studies have reported different changes in cytochrome C oxidase (Cyt) redox status during similar interventions that cause tissue ischaemia. We investigated whether there were distinctive differences when NIRS signals were obtained simultaneously from different tissues during total circulatory arrest. Forty-two healthy 10 kg commercial swine (Sus scrofa) on cardiopulmonary bypass, each underwent 2 to 8 sequential periods of hypothermic circulatory arrest for 7.5 min. Prior to each arrest, key physiologic variables were adjusted to 1 of 81 combinations of high, normal, or low levels of core temperature, hematocrit, pH, and serum glucose. Each combination was repeated at least twice. Simultaneous NIRS monitoring yielded 202 brain, 191 spine, and 199 muscle Cyt data sets, which were then classified into 13 distinctive patterns of change. The data sets always differed between tissues in the same arrest trial and subject. Typically, brain Cyt rapidly became more reduced at the start of arrest and changed little thereafter, muscle Cyt behaved comparably to brain Cyt but continued to become reduced throughout the arrest, and spine Cyt either did not change status or gradually became more reduced over the course of arrest. The spine pattern's mean rate of change was 12 times slower than those of the brain or muscle. The Cyt patterns of change were classified into 13 groups which were significantly related to core temperature in the brain and spine, and hematocrit in muscle. The respiratory response in mitochondria during systemic circulatory arrest differs between brain, spine and muscle tissues in the same subject.
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Affiliation(s)
- Roy E Gagnon
- Dept Pediatrics, Dept Surgery, Children's and Women's Health Centre, University of British Columbia, Vancouver, Canada
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Othman Z, Lenke LG, Bolon SM, Padberg A. Hypotension-induced loss of intraoperative monitoring data during surgical correction of scheuermann kyphosis: a case report. Spine (Phila Pa 1976) 2004; 29:E258-65. [PMID: 15187651 DOI: 10.1097/01.brs.0000127193.89438.b7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Presentation of a case report of Scheuermann kyphosis surgical correction. OBJECTIVE To describe a scenario where both neurogenic mixed evoked potentials and somatosensory-evoked potentials were lost due solely to hypotension before any correction of a kyphotic spinal deformity was performed. SUMMARY OF BACKGROUND DATA Multimodality intraoperative neurophysiologic monitoring of the spinal cord has become widely utilized during surgical correction of scoliotic and kyphotic deformities. Most spinal surgeries also benefit from a state of hypotension to minimize blood loss, but unchecked and persistent hypotension may lead to inadequate perfusion to the spinal cord, resulting in spinal cord dysfunction noted by diminution of neuromonitoring data. METHODS An 18-year-old boy with a 95 degrees Scheuermann kyphosis underwent a posterior spinal fusion for correction of his deformity. Intraoperative neurophysiologic monitoring consisting of neurogenic mixed evoked potentials and somatosensory-evoked potentials were performed throughout surgery. RESULTS After placement of segmental pedicle screw fixation points and multiple osteotomies, before any instrumented correction of the deformity, all lower extremity neuromonitoring data were acutely lost. The surgeon was immediately warned of the data loss, with the mean arterial pressure noted to be 50 mm Hg. The mean arterial pressure was raised with the use of epinephrine bolus and dopamine infusion. Subsequently, all lower extremity neuromonitoring data returned. A Stagnara wake-up test was performed, which the patient passed, and the surgical correction was performed with his pressure maintained on a dopamine infusion. He awakened without neurologic deficits and had an uneventful recovery. CONCLUSIONS Although a state of mild hypotension may be beneficial to limit blood loss during spinal deformity corrective surgery, acute and/or prolonged hypotension may jeopardize spinal cord vascularity and should be avoided especially during surgical treatment of high-risk deformities such as kyphosis. Early warning by multimodality physiologic neuromonitoring appears to be a useful method to alert surgeons of the potentially devastating problem of hypotension-induced spinal cord dysfunction and allows immediate corrective actions.
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Affiliation(s)
- Zanariah Othman
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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Lyon R, Lieberman JA, Grabovac MT, Hu S. Strategies for Managing Decreased Motor Evoked Potential Signals While Distracting the Spine During Correction of Scoliosis. J Neurosurg Anesthesiol 2004; 16:167-70. [PMID: 15021289 DOI: 10.1097/00008506-200404000-00012] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Surgical correction of kyphoscoliosis may result in spinal cord injury and neurologic deficits. Monitoring somatosensory evoked potentials (SSEPs) and transcranial motor evoked potentials (MEPs) intraoperatively may allow for early detection and reversal of spinal cord injury. Controlled hypotension and isovolemic hemodilution are often used during these cases to reduce blood loss and transfusion. However, these physiologic parameters may affect the quality of SSEP and MEP signals. Acute reduction or loss of MEP or SSEP signals during spinal distraction presents a crisis for the operative team: should distraction be immediately relieved? The authors describe three patients who showed a decrease in evoked potential signals under hypotensive, hemodiluted conditions at the stage of spinal distraction. Each case illustrates a different strategy for successful management of these patients.
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Affiliation(s)
- Russ Lyon
- Department of Neurosurgery, University of California, San Francisco, CA 94143-0648, USA
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Gagnon RE, Macnab AJ, Gagnon FA, Blackstock D, LeBlanc JG. Comparison of two spatially resolved NIRS oxygenation indices. J Clin Monit Comput 2004; 17:385-91. [PMID: 14650633 DOI: 10.1023/a:1026274124837] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
UNLABELLED We compared the percentage haemoglobin oxygenation indices from two near infrared spectrophotometers (NIRS) to determine whether the devices reported similar changes in response to induced changes in oxygenation. METHODS 24 healthy juvenile swine undergoing cardiac bypass surgery had INVOS 5100 and NIRO-300 sensors applied to the brow. Induced events included circulatory arrest, altered blood flow rate, core cooling, and re-warming. RESULTS The average data collection was 4 hours 36 minutes and had an r = 0.82 mean correlation between the INVOS and NIRO. The total resting baseline collection from all trials (8,590 pairs) had a correlation of r = 0.62. The average relationship between the INVOS and NIRO was non-linear: an INVOS regional oxygen saturation index (rSO2) of 0% was equivalent to a NIRO tissue oxygenation index (TOI) of 36.2%; values were equal at 56.8%; and an (rSO2) of 100% was equivalent to a TOI 85.9%. There was good or excellent agreement (r > 0.5) between the (rSO2) and TOI patterns of change during induced events in 96% of trials. The INVOS and NIRO were most closely correlated when an attenuation filter was used to obtain identical emitter/detector separations. CONCLUSIONS There was close agreement between the INVOS 5100 and NIRO-300 in response to major physiological change, although absolute values of (rSO2) and TOI were not identical. There was less agreement during baseline measurements or minimal physiologic change.
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Affiliation(s)
- Roy E Gagnon
- Department of Pediatrics, Children's & Women's Health Centre, University of British Columbia, Vancouver, Canada.
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