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Near Infrared Spectroscopy for Intraoperative Monitoring of the Spinal Cord

Macnab, Andrew J., MD, FRCPC; Gagnon, Roy E., DTech; Gagnon, Faith A., HBSc

Basic Science
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Study Design.  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.

Summary of Background Data.  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.

From the Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.

Presented as a poster at the European Society for Paediatric Research, Copenhagen, June 19, 1999, and published as an abstract in Pediatric Research (conference proceedings).

Acknowledgment date: December 19, 2000.

First revision date: March 15, 2001.

Acceptance date: May 29, 2001.

Device status category: 7.

Conflict of interest category: 14.

Address reprint requests to

Andrew Macnab, MD, FRCPC

Division of Critical Care, 2L5

Children’s and Women’s Health Centre of British Columbia

4480 Oak Street

Vancouver, British Columbia

Canada V6H 3V4

E-mail: regagnon@interchange.ubc.ca

© 2002 Lippincott Williams & Wilkins, Inc.