TY - JOUR
T1 - Neurophysiological and paraspinal oximetry monitoring to detect spinal cord ischemia in patients during and after descending aortic repair
T2 - An international multicenter explorative study
AU - Oostveen, Cheryl N.
AU - Weerwind, Patrick W.
AU - Bergs, Paul P. E.
AU - Schmidli, Jurg
AU - Buhlmann, Roman
AU - Schefold, Joerg C.
AU - Eberle, Balthasar
AU - Consiglio, Jolanda
AU - Schaelte, Gereon
AU - Kotelis, Drosos
AU - Hollands, Angelique W. H.
AU - Buhre, Wolfgang F. F. A.
AU - Schurink, Geert Willem H.
AU - Jacobs, Michael J.
AU - van Mook, Walther N. K. A.
AU - Mess, Werner H.
AU - Sutedja, Nadia A.
N1 - Publisher Copyright:
© 2020 The Authors
PY - 2020/3
Y1 - 2020/3
N2 - Background: During descending aortic repair, critically decreased blood flow to the myelum can result in ischemic spinal cord injury and transient or permanent paraplegia. Assessment of motor evoked potentials (MEPs) has been shown to be a valuable tool which allows to detect spinal cord ischemia (SCI) intraoperatively within a therapeutic window suitable to prevent progression to paraparesis or paraplegia. MEP monitoring is not feasible during postoperative care in the awakening patient. Therefore, ancillary techniques to monitor integrity of spinal cord function are needed to detect delayed spinal cord ischemia.Objective: The purpose of this study is to evaluate whether assessment of long loop reflexes (LLR; F-waves) and paraspinal muscle oximetry using Near-Infrared Spectroscopy (NIRS) are feasible and valid in detecting delayed SCI.Methods: We aim to include patients from three tertiary referral centers undergoing aortic repair with MEP monitoring in this study. F-wave measurements and paraspinal NIRS oximetry will be operated intra- and postoperatively. Measurement characteristics and feasibility will be assessed in the first 25 patients. Subsequently, a second cohort of 75 patients will be investigated to determine the sensitivity and specificity of F-waves and NIRS in detecting perioperative SCI. In this context for the MEP group SCI is defined intraoperatively as significant MEP changes and postoperatively as newly developed paraplegia.Conclusions: A clinical study design and protocol is proposed to assess if F-waves and/or NIRS-based paraspinal oximetry are feasible and valid in detecting and monitoring for occurrences of delayed SCI.
AB - Background: During descending aortic repair, critically decreased blood flow to the myelum can result in ischemic spinal cord injury and transient or permanent paraplegia. Assessment of motor evoked potentials (MEPs) has been shown to be a valuable tool which allows to detect spinal cord ischemia (SCI) intraoperatively within a therapeutic window suitable to prevent progression to paraparesis or paraplegia. MEP monitoring is not feasible during postoperative care in the awakening patient. Therefore, ancillary techniques to monitor integrity of spinal cord function are needed to detect delayed spinal cord ischemia.Objective: The purpose of this study is to evaluate whether assessment of long loop reflexes (LLR; F-waves) and paraspinal muscle oximetry using Near-Infrared Spectroscopy (NIRS) are feasible and valid in detecting delayed SCI.Methods: We aim to include patients from three tertiary referral centers undergoing aortic repair with MEP monitoring in this study. F-wave measurements and paraspinal NIRS oximetry will be operated intra- and postoperatively. Measurement characteristics and feasibility will be assessed in the first 25 patients. Subsequently, a second cohort of 75 patients will be investigated to determine the sensitivity and specificity of F-waves and NIRS in detecting perioperative SCI. In this context for the MEP group SCI is defined intraoperatively as significant MEP changes and postoperatively as newly developed paraplegia.Conclusions: A clinical study design and protocol is proposed to assess if F-waves and/or NIRS-based paraspinal oximetry are feasible and valid in detecting and monitoring for occurrences of delayed SCI.
KW - Spinal cord ischemia
KW - Neurophysiological monitoring techniques
KW - NIRS oximetry
KW - Descending aortic repair
KW - Thoracoabdominal aortic aneurysm repair
KW - NEAR-INFRARED SPECTROSCOPY
U2 - 10.1016/j.conctc.2020.100545
DO - 10.1016/j.conctc.2020.100545
M3 - Article
C2 - 32181411
SN - 2451-8654
VL - 17
JO - Contemporary Clinical Trials Communications
JF - Contemporary Clinical Trials Communications
M1 - 100545
ER -