Intraoperative assessment of human spinal cord perfusion using near infrared spectroscopy with indocyanine green tracer technique

• Published in: The spine journal Vol. 13; no. 12; pp. 1818 - 1825
• Main Authors: Amiri, Amir Reza, MRCS, Lee, Cheong Hung, MRCS, Leung, Terence S., PhD, Hetreed, Michael, FRCA, Craggs, Michael D., PhD, Casey, Adrian T.H., FRCS(SN)
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2013
• Subjects: Aged; Carbon Dioxide - analysis; Carbon Dioxide - metabolism; Carbon dioxide reactivity; Female; Human; Humans; Indocyanine Green; Intraoperative Neurophysiological Monitoring - methods; Intraoperative spinal cord monitoring; Male; Middle Aged; Near infrared spectroscopy; Orthopedics; Spectroscopy, Near-Infrared - methods; Spinal Cord - blood supply; Spinal cord perfusion; Near infrared spectroscopy; Human; Carbon dioxide reactivity; Spinal cord perfusion; Intraoperative spinal cord monitoring
• ISSN: 1529-9430; 1878-1632
• DOI: 10.1016/j.spinee.2013.05.054

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.