Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland; University Spine Center, Balgrist University Hospital, Zurich, Switzerland; Institute of Physiology, University of Zurich, Zurich, Switzerland.
Institute of Physiology, University of Zurich, Zurich, Switzerland.
J Clin Neurosci. 2024 Oct;128:110803. doi: 10.1016/j.jocn.2024.110803. Epub 2024 Aug 19.
Timely and sufficient decompression are critical objectives in degenerative cervical myelopathy (DCM) and spinal cord injury (SCI). We previously investigated intraoperative cerebrospinal fluid pressure (CSFP) for determining surgical outcomes. However, confounding factors during the intra- and postoperative setting need consideration. These are related to type of respiration (i.e., artificial vs. natural) and anesthesia, which affect CSFP dynamics through the interaction between the cardiorespiratory system and the CSF compartment. This retrospective cohort study (NCT02170155) aims to systematically investigate these factors to facilitate CSFP interpretation. CSFP was continuously measured through a lumbar catheter, intra- and postoperatively, in 21 patients with DCM undergoing decompression surgery. Mean CSFP and cardiac-driven CSFP peak-to-valley amplitude (CSFPp) were analyzed throughout the perioperative period, including the immediate extubation period in eight patients. Intraoperative mean CSFP had a median value and {interquartile range} of 10.8 {5.5} mmHg and increased 1.6-fold to 16.9 {7.1} mmHg postoperatively (p < 0.001). CSFPp increased 3-fold from 0.6 {0.7} to 1.8 {2.5} mmHg (p = 0.001). Increased CSFP persisted overnight. During extubation, there was a notable increase in CSFP and CSFPp of 14.0 {5.8} and 5.1 {3.1} mmHg, respectively. From case-based analysis, this was attributed to an arterial pCO increase. There was no correlation between respirator settings and CSFP metrics. There were distinct and quantifiable changes in CSFP dynamics from the intra- to postoperative setting related to type of respiration, anesthesia, and level of consciousness. When monitoring CSFP dynamics in spine surgery across these settings, cardiorespiratory factors must be controlled for.
及时和充分减压是退行性颈椎脊髓病（DCM）和脊髓损伤（SCI）的关键目标。我们之前研究了术中脑脊髓液压力（CSFP）以确定手术结果。然而，在围手术期需要考虑到混杂因素。这些因素与呼吸类型（即人工呼吸与自然呼吸）和麻醉有关，通过心肺系统和脑脊液腔之间的相互作用影响 CSFP 动力学。这项回顾性队列研究（NCT02170155）旨在系统地研究这些因素，以促进 CSFP 解释。通过腰椎导管连续测量 21 例接受减压手术的 DCM 患者的 CSFP，在术中及术后进行测量。分析整个围手术期的平均 CSFP 和心脏驱动的 CSFP 峰谷幅度（CSFPp），包括 8 例患者即刻拔管期间的 CSFPp。术中平均 CSFP 的中位数和四分位距为 10.8 {5.5} mmHg，术后增加 1.6 倍至 16.9 {7.1} mmHg（p < 0.001）。CSFPp 从 0.6 {0.7} 增加到 1.8 {2.5} mmHg，增加了 3 倍（p = 0.001）。CSFP 增加持续到夜间。拔管期间，CSFP 和 CSFPp 分别显著增加 14.0 {5.8} 和 5.1 {3.1} mmHg。从病例分析来看，这归因于动脉 pCO 增加。呼吸机能设置与 CSFP 指标之间没有相关性。与呼吸类型、麻醉和意识水平有关，CSFP 动力学从术中到术后设置有明显和可量化的变化。在这些设置下监测 CSFP 动力学时，必须控制心肺因素。
