Near-Infrared Spectroscopy for Spinal Cord Monitoring—A Roadmap to Translational Research in Aortic Medicine

Aorta, 2023 · DOI: https://doi.org/10.1055/s-0043-1772774 · Published: November 10, 2023

Spinal Cord Injury Cardiovascular Science Medical Imaging

Simple Explanation

This article discusses using near-infrared spectroscopy (NIRS) to monitor the spinal cord during aortic aneurysm repair. Spinal cord injury is a significant risk during these procedures. Conventional methods of spinal cord monitoring are invasive and not always practical. NIRS offers a non-invasive way to assess spinal cord oxygenation in real-time. The approach involves monitoring the 'collateral network,' a network of blood vessels around the spinal cord, to infer the oxygenation status of the spinal cord itself.

Study Duration

Not specified

Participants

Large animal models (pigs) and clinical studies with human patients (e.g., 20 patients in one study, 109 in another)

Evidence Level

Not specified

Key Findings

1
Lumbar cnNIRS reproducibly reflects spinal cord tissue oxygenation and perfusion in real time and appears a feasible method for clinical practice.
2
cnNIRS reacts to open and endovascular SA sacriﬁce, functioning as a promising new tool for guiding spinal cord protective procedures such as MIS2ACE.
3
Both experimentally and clinically, it has been demonstrated that cnNIRS correlates with postoperative neurologic outcome and other established monitoring modalities such as MEP and SSEP with high speciﬁcity.

Research Summary

The article reviews translational research on using collateral network near-infrared spectroscopy (cnNIRS) for spinal cord monitoring during aortic repair. Studies in animal models and clinical settings suggest that cnNIRS can effectively reflect spinal cord oxygenation and detect ischemia during aortic procedures. The authors conclude that cnNIRS is a promising non-invasive tool for real-time spinal cord monitoring, with potential to guide spinal cord protective procedures, though further research is needed.

Practical Implications

Real-time Spinal Cord Monitoring

cnNIRS offers a non-invasive method for real-time monitoring of spinal cord oxygenation during aortic surgeries, potentially allowing for quicker intervention in cases of ischemia.

Guidance for Protective Procedures

cnNIRS can be used to guide spinal cord protective procedures like MIS2ACE by providing real-time feedback on the effects of segmental artery occlusion.

Optimization of Optode Placement

Expanded optode placement patterns (T7-L5) may improve the versatility of cnNIRS for various aortic procedures, including those limited to the proximal thoracic aorta.

Study Limitations

1
Further studies are warranted to generate adequate power for meaningful conclusions above and beyond current preliminary results.
2
Additional clinical and experimental research is warranted to further investigate cnNIRS with regard to different patient- and procedural-related aspects
3
Measurement thresholds indicative of imminent SCI and prolonged monitoring periods beyond 48 hours to account for potential delayed paraplegia

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