title: Optical monitoring and detection of spinal cord ischemia.
abstract: Spinal cord ischemia can lead to paralysis or paraparesis, but if detected early it may be amenable to treatment. Current methods use evoked potentials for detection of spinal cord ischemia, a decades old technology whose warning signs are indirect and significantly delayed from the onset of ischemia. Here we introduce and demonstrate a prototype fiber optic device that directly measures spinal cord blood flow and oxygenation. This technical advance in neurological monitoring promises a new standard of care for detection of spinal cord ischemia and the opportunity for early intervention. We demonstrate the probe in an adult Dorset sheep model. Both open and percutaneous approaches were evaluated during pharmacologic, physiological, and mechanical interventions designed to induce variations in spinal cord blood flow and oxygenation. The induced variations were rapidly and reproducibly detected, demonstrating direct measurement of spinal cord ischemia in real-time. In the future, this form of hemodynamic spinal cord diagnosis could significantly improve monitoring and management in a broad range of patients, including those undergoing thoracic and abdominal aortic revascularization, spine stabilization procedures for scoliosis and trauma, spinal cord tumor resection, and those requiring management of spinal cord injury in intensive care settings.
authors.affiliation: Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America ; Institute of Physics, University of Campinas, Campinas, São Paulo, Brazil.
authors.forename: Rickson C
authors.initials: RC
authors.lastname: Mesquita
authors.affiliation: Department of Anesthesiology, Stony Brook University Medical Center, Stony Brook, New York, United States of America ; Department of Biomedical Engineering, Stony Brook University Medical Center, Stony Brook, New York, United States of America.
authors.forename: Angela
authors.initials: A
authors.lastname: D'Souza
authors.affiliation: Department of Surgery, Stony Brook University Medical Center, Stony Brook, New York, United States of America.
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Bilfinger
authors.affiliation: Department of Neurosurgery, Stony Brook University Medical Center, Stony Brook, New York, United States of America.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Galler
authors.affiliation: Department of Anesthesiology, Stony Brook University Medical Center, Stony Brook, New York, United States of America.
authors.forename: Asher
authors.initials: A
authors.lastname: Emanuel
authors.affiliation: Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.
authors.forename: Steven S
authors.initials: SS
authors.lastname: Schenkel
authors.affiliation: Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.
authors.forename: Arjun G
authors.initials: AG
authors.lastname: Yodh
authors.affiliation: Department of Anesthesiology, Stony Brook University Medical Center, Stony Brook, New York, United States of America ; Department of Biomedical Engineering, Stony Brook University Medical Center, Stony Brook, New York, United States of America.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Floyd
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D005336:Fiber Optic Technology / Q000379:methods*; D006801:Humans; D016343:Monitoring, Intraoperative / Q000379:methods*; D012039:Regional Blood Flow; D012756:Sheep; D013057:Spectrum Analysis / Q000379:methods; D013116:Spinal Cord / Q000098:blood supply; D013119:Spinal Cord Injuries / Q000150:complications / Q000601:surgery; D020760:Spinal Cord Ischemia / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology / Q000601:surgery*