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Florence TJ, Bari A, Vivas AC. Functional Stimulation and Imaging to Predict Neuromodulation of Chronic Low Back Pain. Neurosurg Clin N Am 2024; 35:191-197. [PMID: 38423734 DOI: 10.1016/j.nec.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Back pain is one of the most common aversive sensations in human experience. Pain is not limited to the sensory transduction of tissue damage; rather, it encompasses a range of nervous system activities including lateral modulation, long-distance transmission, encoding, and decoding. Although spine surgery may address peripheral pain generators directly, aberrant signals along canonical aversive pathways and maladaptive influence of affective and cognitive states can result in persistent subjective pain refractory to classical surgical intervention. The clinical identification of who will benefit from surgery-and who will not-is increasingly grounded in neurophysiology.
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Affiliation(s)
- Timothy J Florence
- UCLA Neurosurgery, 300 Stein Plaza Driveway, Suite 562, Los Angeles, CA 90095, USA
| | - Ausaf Bari
- UCLA Neurosurgery, 300 Stein Plaza Driveway, Suite 562, Los Angeles, CA 90095, USA
| | - Andrew C Vivas
- UCLA Neurosurgery, 300 Stein Plaza Driveway, Suite 562, Los Angeles, CA 90095, USA.
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Bessen MA, Gayen CD, Quarrington RD, Walls AC, Leonard AV, Kurtcuoglu V, Jones CF. Characterising spinal cerebrospinal fluid flow in the pig with phase-contrast magnetic resonance imaging. Fluids Barriers CNS 2023; 20:5. [PMID: 36653870 PMCID: PMC9850564 DOI: 10.1186/s12987-022-00401-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/13/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Detecting changes in pulsatile cerebrospinal fluid (CSF) flow may assist clinical management decisions, but spinal CSF flow is relatively understudied. Traumatic spinal cord injuries (SCI) often cause spinal cord swelling and subarachnoid space (SAS) obstruction, potentially causing pulsatile CSF flow changes. Pigs are emerging as a favoured large animal SCI model; therefore, the aim of this study was to characterise CSF flow along the healthy pig spine. METHODS Phase-contrast magnetic resonance images (PC-MRI), retrospectively cardiac gated, were acquired for fourteen laterally recumbent, anaesthetised and ventilated, female domestic pigs (22-29 kg). Axial images were obtained at C2/C3, T8/T9, T11/T12 and L1/L2. Dorsal and ventral SAS regions of interest (ROI) were manually segmented. CSF flow and velocity were determined throughout a cardiac cycle. Linear mixed-effects models, with post-hoc comparisons, were used to identify differences in peak systolic/diastolic flow, and maximum velocity (cranial/caudal), across spinal levels and dorsal/ventral SAS. Velocity wave speed from C2/C3 to L1/L2 was calculated. RESULTS PC-MRI data were obtained for 11/14 animals. Pulsatile CSF flow was observed at all spinal levels. Peak systolic flow was greater at C2/C3 (dorsal: - 0.32 ± 0.14 mL/s, ventral: - 0.15 ± 0.13 mL/s) than T8/T9 dorsally (- 0.04 ± 0.03 mL/s; p < 0.001), but not different ventrally (- 0.08 ± 0.08 mL/s; p = 0.275), and no difference between thoracolumbar levels (p > 0.05). Peak diastolic flow was greater at C2/C3 (0.29 ± 0.08 mL/s) compared to T8/T9 (0.03 ± 0.03 mL/s, p < 0.001) dorsally, but not different ventrally (p = 1.000). Cranial and caudal maximum velocity at C2/C3 were greater than thoracolumbar levels dorsally (p < 0.001), and T8/T9 and L1/L2 ventrally (p = 0.022). Diastolic velocity wave speed was 1.41 ± 0.39 m/s dorsally and 1.22 ± 0.21 m/s ventrally, and systolic velocity wave speed was 1.02 ± 0.25 m/s dorsally and 0.91 ± 0.22 m/s ventrally. CONCLUSIONS In anaesthetised and ventilated domestic pigs, spinal CSF has lower pulsatile flow and slower velocity wave propagation, compared to humans. This study provides baseline CSF flow at spinal levels relevant for future SCI research in this animal model.
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Affiliation(s)
- Madeleine Amy Bessen
- grid.1010.00000 0004 1936 7304Adelaide Spinal Research Group and Centre for Orthopaedics and Trauma Research, Adelaide Medical School, The University of Adelaide, Level 7, Adelaide Health and Medical Sciences Building, The University of Adelaide, North Terrace, Adelaide, SA 5005 Australia
| | - Christine Diana Gayen
- grid.1010.00000 0004 1936 7304Adelaide Spinal Research Group and Centre for Orthopaedics and Trauma Research, Adelaide Medical School, The University of Adelaide, Level 7, Adelaide Health and Medical Sciences Building, The University of Adelaide, North Terrace, Adelaide, SA 5005 Australia ,grid.1010.00000 0004 1936 7304Translational Neuropathology Laboratory, School of Biomedicine, The University of Adelaide, Level 2, Helen Mayo North Building, The University of Adelaide, Frome Road, Adelaide, SA 5005 Australia
| | - Ryan David Quarrington
- grid.1010.00000 0004 1936 7304Adelaide Spinal Research Group and Centre for Orthopaedics and Trauma Research, Adelaide Medical School, The University of Adelaide, Level 7, Adelaide Health and Medical Sciences Building, The University of Adelaide, North Terrace, Adelaide, SA 5005 Australia ,grid.1010.00000 0004 1936 7304School of Electrical and Mechanical Engineering, The University of Adelaide, North Terrace, Adelaide, SA 5005 Australia
| | - Angela Catherine Walls
- grid.430453.50000 0004 0565 2606Clinical and Research Imaging Centre, South Australian Health and Medical Research Institute, National Imaging Facility, Northern Pod, SAHMRI, North Terrace, Adelaide, SA 5000 Australia
| | - Anna Victoria Leonard
- grid.1010.00000 0004 1936 7304Translational Neuropathology Laboratory, School of Biomedicine, The University of Adelaide, Level 2, Helen Mayo North Building, The University of Adelaide, Frome Road, Adelaide, SA 5005 Australia
| | - Vartan Kurtcuoglu
- grid.7400.30000 0004 1937 0650Institute of Physiology, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland ,grid.7400.30000 0004 1937 0650Zurich Center for Integrative Human Physiology, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland ,grid.7400.30000 0004 1937 0650Neuroscience Center Zurich, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Claire Frances Jones
- grid.1010.00000 0004 1936 7304Adelaide Spinal Research Group and Centre for Orthopaedics and Trauma Research, Adelaide Medical School, The University of Adelaide, Level 7, Adelaide Health and Medical Sciences Building, The University of Adelaide, North Terrace, Adelaide, SA 5005 Australia ,grid.1010.00000 0004 1936 7304School of Electrical and Mechanical Engineering, The University of Adelaide, North Terrace, Adelaide, SA 5005 Australia ,grid.416075.10000 0004 0367 1221Department of Orthopaedics, Royal Adelaide Hospital, Adelaide, SA 5000 Australia
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Relationship between lumbar spinal stenosis and cauda equina movement during the Valsalva maneuver. Skeletal Radiol 2023; 52:1349-1358. [PMID: 36609720 DOI: 10.1007/s00256-022-04274-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/23/2022] [Accepted: 12/29/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To confirm the relationship between lumbar spinal stenosis (LSS) and cauda equina movement during the Valsalva maneuver. MATERIALS AND METHODS Two radiologists at our institution independently evaluated cauda equina movement on pelvic cine MRI, which was performed for urethrorrhea after prostatectomy or pelvic prolapse in 105 patients (99 males; mean age: 69.0 [range: 50-78] years), who also underwent abdominopelvic CT within 2 years before or after the MRI. The qualitative assessment of the cine MRI involved subjective determination of the cauda equina movement type (non-movement, flutter, and inchworm-manner). The severity of LSS on abdominopelvic CT was quantified using our LSS scoring system and performed between L1/2 and L5/S1. We calculated the average LSS scores of two analysts and extracted the worst scores among all levels. RESULTS Cauda equina movement was observed in 15 patients (14%), inchworm-manner in 10 patients, and flutter in five patients. Participants with cauda equina movement demonstrated significantly higher LSS scores than those without movement (P < 0.001, Wilcoxon's rank-sum test). A significant difference was observed in the worst LSS scores between participants without movement and those with inchworm-manner movement (P < 0.001, Bonferroni's corrected). There were no significant differences between participants without movement and those with flutter movement (P = 0.3156) and between participants with flutter movement and those with inchworm-manner movement (P = 0.4843). CONCLUSION Cauda equina movement in cine MRI during the Valsalva maneuver is occasionally observed in patients with severe LSS, and may be associated with pathogenesis of redundant nerve roots.
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