Kheram Najmeh, Bessen Madeleine A, Jones Claire F, Davies Benjamin M, Kotter Mark, Farshad Mazda, Hupp Markus, Nanz Daniel, Freund Patrick, Schubert Martin, Kurtcuoglu Vartan, Curt Armin, Zipser Carl M
Spinal Cord Injury Center and Department of Neurology and Neurophysiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
University Spine Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
Brain Spine. 2025 Feb 12;5:104211. doi: 10.1016/j.bas.2025.104211. eCollection 2025.
In patients with acute spinal cord injury (SCI) and degenerative cervical myelopathy (DCM), spinal cord compression is considered a main contributor to spinal cord damage, associated with cerebrospinal fluid (CSF) space obstruction. CSF pressure (CSFP) dynamics are studied as a potential indirect biomechanical marker for spinal cord compression, and as a proxy to estimate spinal cord perfusion pressure (SCPP).
Evidence for safety and feasibility of CSFP dynamics in clinical trials as well as interrelations with neuroimaging and intraspinal pressure, and relation to preclinical CSFP models.
Systematic review. This review followed PRISMA guidelines, risk of bias assessment with ROBINS-I tool, PROSPERO registration (CRD42024545629).
11 relevant papers were identified (n = 212 patients, n = 194 intraoperative, n = 18 bedside). Risk of bias for safety reporting was low-moderate. Intraoperative CSFP assessments were commonly performed in acute SCI. CSFP was assessed to calculate SCPP (7/11), to evaluate effects from surgical decompression (5/11) and for therapeutic CSF drainage (3/11). The adverse event rate associated with the intrathecal catheter was 8% (n = 15/194).
The preliminary safety and feasibility profile of CSFP assessments in spinal cord compression encourages clinical application. However, a deeper risk-benefit analysis is limited as the clinical value is not yet determined, given challenges of defining disease specific critical CSFP and SCPP thresholds. The interrelation between measures of CSFP and neuroimaging is yet to be proven. Targeted preclinical studies are essential to improve our understanding of complex CSFP-cord compression interrelations.
在急性脊髓损伤（SCI）和退行性颈椎脊髓病（DCM）患者中，脊髓受压被认为是脊髓损伤的主要原因，与脑脊液（CSF）间隙梗阻有关。脑脊液压力（CSFP）动力学作为脊髓受压的潜在间接生物力学标志物以及估计脊髓灌注压（SCPP）的替代指标进行研究。
CSFP动力学在临床试验中的安全性和可行性证据，以及与神经影像学和椎管内压力的相互关系，以及与临床前CSFP模型的关系。
系统评价。本评价遵循PRISMA指南，使用ROBINS-I工具进行偏倚风险评估，在PROSPERO注册（CRD42024545629）。
确定了11篇相关论文（n = 212例患者，n = 194例术中，n = 18例床边）。安全报告的偏倚风险为低至中度。术中CSFP评估通常在急性SCI中进行。评估CSFP以计算SCPP（7/11），评估手术减压效果（5/11）以及用于治疗性脑脊液引流（3/11）。鞘内导管相关的不良事件发生率为8%（n = 15/194）。
CSFP评估在脊髓受压中的初步安全性和可行性概况鼓励临床应用。然而，由于尚未确定疾病特异性的关键CSFP和SCPP阈值存在挑战，临床价值尚未确定，因此更深入的风险效益分析受到限制。CSFP测量与神经影像学之间的相互关系尚待证实。有针对性的临床前研究对于提高我们对复杂的CSFP-脊髓受压相互关系的理解至关重要。
