Effects of remote ischemic preconditioning on biochemical markers and neurologic outcomes in patients undergoing elective cervical decompression surgery: a prospective randomized controlled trial.
BACKGROUND
Remote ischemic preconditioning (RIPC) may protect the spinal cord from ischemic injury. This randomized clinical trial was designed to assess whether a large clinical trial testing the effect of RIPC on neurologic outcome in patients undergoing spine surgery is warranted. This trial was registered with ClinicalTrials.gov, number NCT00778323.


METHODS
Forty adult cervical spondylotic myelopathy patients undergoing elective decompression surgery were randomly assigned to either the RIPC group (n=20) or the control group (n=20). Limb RIPC consisted of three 5-minutes cycles of upper right limb ischemia with intervening 5-minute periods of reperfusion. Neuron-specific enolase and S-100B levels were measured in serum at set time points. Median nerve somatosensory-evoked potentials (SEPs) were also recorded. Neurologic recovery rate was evaluated using a Japanese Orthopaedic Association scale.


RESULTS
RIPC significantly reduced serum S-100B release at 6 hours and 1 day after surgery, and reduced neuron-specific enolase release at 6 hours, and then at 1, 3, and 5 days after surgery. No differences were observed in SEP measurements or the incidence of SEP changes during surgery between the control and RIPC groups. Recovery rate at 7 days, and at 1 and 3 months after surgery was higher in the RIPC group than in the control group (P<0.05).


CONCLUSIONS
Our results for markers of neuronal ischemic injury and rate of recovery suggest that a clinical trial with sufficient statistical power to detect an effect of RIPC on the incidence of neurologic complications (paresis, palsy, etc) due to spinal cord ischemia-reperfusion injury after spine surgery is warranted [corrected].
Hu
Sheng
S
Department of Anesthesiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China.
Dong
Hai-long
HL
Li
Yi-zhi
YZ
Luo
Zhuo-jing
ZJ
Sun
Long
L
Yang
Qian-zi
QZ
Yang
Li-fang
LF
Xiong
Lize
L
D015415:Biomarkers / Q000097:blood; D002574:Cervical Vertebrae / Q000601:surgery*; D002681:China; D019299:Decompression, Surgical / Q000379:methods*; D017558:Elective Surgical Procedures; D005073:Evoked Potentials, Somatosensory; D005260:Female; D006801:Humans; D019194:Ischemic Preconditioning / Q000379:methods*; D008297:Male; D008475:Median Nerve; D008875:Middle Aged; D009414:Nerve Growth Factors / Q000097:blood*; D010751:Phosphopyruvate Hydratase / Q000097:blood*; D011446:Prospective Studies; D015427:Reperfusion Injury / Q000517:prevention & control*; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins / Q000097:blood*; D055009:Spondylosis / Q000601:surgery; D016896:Treatment Outcome; D034941:Upper Extremity
D015415:Biomarkers; D009414:Nerve Growth Factors; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins; D010751:Phosphopyruvate Hydratase