Cerebrospinal fluid pressure dynamics across the intra- and postoperative setting: Retrospective study of a spine surgery cohort.

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  • Additional Information
    • Source:
      Publisher: Churchill Livingstone Country of Publication: Scotland NLM ID: 9433352 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-2653 (Electronic) Linking ISSN: 09675868 NLM ISO Abbreviation: J Clin Neurosci Subsets: MEDLINE
    • Publication Information:
      Publication: <2000->: Edinburgh : Churchill Livingstone
      Original Publication: Melbourne, Vic., Australia : Churchill Livingstone, c1994-
    • Subject Terms:
      Cerebrospinal Fluid Pressure*/physiology ; Decompression, Surgical*/methods; Humans ; Retrospective Studies ; Male ; Female ; Middle Aged ; Aged ; Postoperative Period ; Cervical Vertebrae/surgery ; Adult ; Cohort Studies
    • Abstract:
      Timely and sufficient decompression are critical objectives in degenerative cervical myelopathy (DCM) and spinal cord injury (SCI). We previously investigated intraoperative cerebrospinal fluid pressure (CSFP) for determining surgical outcomes. However, confounding factors during the intra- and postoperative setting need consideration. These are related to type of respiration (i.e., artificial vs. natural) and anesthesia, which affect CSFP dynamics through the interaction between the cardiorespiratory system and the CSF compartment. This retrospective cohort study (NCT02170155) aims to systematically investigate these factors to facilitate CSFP interpretation. CSFP was continuously measured through a lumbar catheter, intra- and postoperatively, in 21 patients with DCM undergoing decompression surgery. Mean CSFP and cardiac-driven CSFP peak-to-valley amplitude (CSFPp) were analyzed throughout the perioperative period, including the immediate extubation period in eight patients. Intraoperative mean CSFP had a median value and {interquartile range} of 10.8 {5.5} mmHg and increased 1.6-fold to 16.9 {7.1} mmHg postoperatively (p < 0.001). CSFPp increased 3-fold from 0.6 {0.7} to 1.8 {2.5} mmHg (p = 0.001). Increased CSFP persisted overnight. During extubation, there was a notable increase in CSFP and CSFPp of 14.0 {5.8} and 5.1 {3.1} mmHg, respectively. From case-based analysis, this was attributed to an arterial pCO 2 increase. There was no correlation between respirator settings and CSFP metrics. There were distinct and quantifiable changes in CSFP dynamics from the intra- to postoperative setting related to type of respiration, anesthesia, and level of consciousness. When monitoring CSFP dynamics in spine surgery across these settings, cardiorespiratory factors must be controlled for.
      Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
      (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
    • Contributed Indexing:
      Keywords: Cerebrospinal fluid pressure; Degenerative cervical myelopathy; Spinal cord compression; Spinal cord injury
    • Publication Date:
      Date Created: 20240820 Date Completed: 20240911 Latest Revision: 20240911
    • Publication Date:
      20240912
    • Accession Number:
      10.1016/j.jocn.2024.110803
    • Accession Number:
      39163699