Near infrared spectroscopy for intraoperative monitoring of the spinal cord.
METHODS
Animal model study of three healthy commercial pigs was conducted.


OBJECTIVE
To determine whether near infrared spectroscopic monitoring of the spinal cord is feasible, and whether changes in near infrared spectroscopy correlate with changes in blood flow to the cord or operative maneuvers.


BACKGROUND
Near infrared spectroscopy is a noninvasive continuous monitoring tool capable of measuring absolute changes in the concentration of three chromophores: oxygenated hemoglobin, deoxygenated hemoglobin, and cytochrome aa3, the terminal enzyme in the electron transfer chain and a measure of cellular energy equilibrium. Near infrared spectroscopy has been used to monitor the brain intraoperatively in multiple circumstances. The authors hypothesized that near infrared spectroscopy could be used to monitor the spinal cord's cellular energy equilibrium during spinal surgery (i.e., that vascular compromise could be identified before irreversible damage occurred).


METHODS
The posterior elements of the spine were exposed, and near infrared spectroscopy optodes (fiberoptic bundles) were sutured to either the lamina or the spinous processes of T9, T10, or both and directed toward the spinal cord. Interventions included manipulation of oxygen saturation and distraction of the T9-T10 disc space.


RESULTS
With reduced oxygen delivery (lower arterial oxygen saturation and blood flow), oxygenated hemoglobin concentration decreased and deoxygenated hemoglobin concentration increased. With distraction, blood volume (oxygenated hemoglobin plus deoxygenated hemoglobin) decreased, and cytochrome aa3 became more oxidized. Changes were apparent within 1 second of the intervention beginning, and recovery to the baseline of near infrared spectroscopy occurred with relief of each intervention.


CONCLUSIONS
This near infrared spectroscopy technique monitors changes in oxygenation of the spinal cord, and therefore appears capable of intraoperative warning about impending vascular compromise of the spinal cord.
Macnab
Andrew J
AJ
Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada. regagnon@interchange.ubc.ca
Gagnon
Roy E
RE
Gagnon
Faith A
FA
D000818:Animals; D015687:Cell Hypoxia; D003576:Electron Transport Complex IV / Q000032:analysis / Q000378:metabolism; D006454:Hemoglobins / Q000032:analysis / Q000378:metabolism; D000860:Hypoxia / Q000175:diagnosis* / Q000517:prevention & control; D023421:Models, Animal; D016343:Monitoring, Intraoperative / Q000295:instrumentation / Q000379:methods*; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000295:instrumentation; D010100:Oxygen / Q000378:metabolism; D010865:Pilot Projects; D011237:Predictive Value of Tests; D012039:Regional Blood Flow; D019265:Spectroscopy, Near-Infrared / Q000379:methods*; D013116:Spinal Cord / Q000098:blood supply / Q000378:metabolism*; D020760:Spinal Cord Ischemia / Q000175:diagnosis* / Q000378:metabolism / Q000517:prevention & control; D013314:Stress, Mechanical; D013552:Swine
D006454:Hemoglobins; D003576:Electron Transport Complex IV; D010100:Oxygen