Zipser Carl Moritz, Pfender Nikolai, Spirig Jose Miguel, Betz Michael, Aguirre Jose, Hupp Markus, Farshad Mazda, Curt Armin, Schubert Martin
Department of Neurology and Neurophysiology, Balgrist University Hospital, Zurich, Switzerland
University Spine Center, Balgrist University Hospital, Zurich, Switzerland.
BMJ Open. 2020 Sep 21;10(9):e037332. doi: 10.1136/bmjopen-2020-037332.
INTRODUCTION: Degenerative cervical myelopathy (DCM) is a disabling spinal disorder characterised by sensorimotor deficits of upper and lower limbs, neurogenic bladder dysfunction and neuropathic pain. When suspected, cervical MRI helps to reveal spinal cord compression and rules out alternative diagnoses. However, the correlation between radiological findings and symptoms is weak. Cerebrospinal fluid pressure (CSFP) analysis may complement the appreciation of cord compression and be used for intraoperative and postoperative monitorings in patients undergoing surgical decompression. METHODS AND ANALYSIS: Twenty patients diagnosed with DCM undergoing surgical decompression will receive standardised lumbar CSFP monitoring immediately before, during and 24 hours after operation. Rest (ie, opening pressure, CSF pulsation) and stimulated (ie, Valsalva, Queckenstedt's) CSFP-findings in DCM will be compared with 20 controls and results from CSFP monitoring will be related to clinical and neurophysiological findings. Arterial blood pressure will be recorded perioperatively and postoperatively to calculate spinal cord perfusion pressure and spinal vascular reactivity index. Furthermore, measures of CSFP will be compared with markers of spinal cord compression by means of MR imaging. ETHICS AND DISSEMINATION: The study protocol conformed to the latest revision of the Declaration of Helsinki and was approved by the local Ethics Committee of the University Hospital of Zurich (KEK-ZH number PB-2016-00623). The main publications from this study will cover the CSFP fluid dynamics and pressure analysis preoperative, perioperative and postoperative correlated with imaging, clinical scores and neurophysiology. Other publications will deal with preoperative and postoperative spinal perfusion. Furthermore, we will disseminate an analysis on waveform morphology and the correlation with blood pressure and ECG. Parts of the data will be used for computational modelling of cervical stenosis. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Registry (NCT02170155).
引言：退行性颈椎脊髓病（DCM）是一种致残性脊柱疾病，其特征为上下肢感觉运动功能障碍、神经源性膀胱功能障碍和神经性疼痛。怀疑患有该病时，颈椎磁共振成像（MRI）有助于发现脊髓受压情况并排除其他诊断。然而，影像学检查结果与症状之间的相关性较弱。脑脊液压力（CSFP）分析可能有助于评估脊髓受压情况，并用于接受手术减压患者的术中及术后监测。 方法与分析：20例诊断为DCM并接受手术减压的患者将在手术前、手术期间及术后24小时接受标准化的腰椎CSFP监测。将DCM患者静息状态（即开放压、脑脊液搏动）和激发状态（即瓦尔萨尔瓦动作、奎肯施泰特试验）下的CSFP结果与20名对照者进行比较，并将CSFP监测结果与临床及神经生理学检查结果相关联。围手术期及术后记录动脉血压，以计算脊髓灌注压和脊髓血管反应指数。此外，将通过磁共振成像将CSFP测量结果与脊髓受压标志物进行比较。 伦理与传播：本研究方案符合《赫尔辛基宣言》的最新修订版，并获得苏黎世大学医院当地伦理委员会批准（KEK-ZH编号PB-2016-00623）。本研究的主要出版物将涵盖术前、术中和术后与影像学、临床评分及神经生理学相关的CSFP流体动力学和压力分析。其他出版物将涉及术前和术后的脊髓灌注。此外，我们将发表关于波形形态以及与血压和心电图相关性的分析。部分数据将用于颈椎管狭窄的计算建模。 试验注册号：ClinicalTrials.gov注册库（NCT02170155）
Sensors (Basel). 2025-6-28
Animal Model Exp Med. 2024-10
Acta Neurochir (Wien). 2023-6
J Healthc Eng. 2021
Nat Rev Neurol. 2020-1-23
Quant Imaging Med Surg. 2018-4
BMJ. 2018-2-22
Neurosurg Clin N Am. 2018-1
Neurosurg Clin N Am. 2018-1
Zotero 插件