The Effects of Spinal Cord Injury Induced by Shortening on Motor Evoked Potentials and Spinal Cord Blood Flow
The Effects of Spinal Cord Injury Induced by Shortening on Motor Evoked Potentials and Spinal Cord Blood Flow
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DOI：
10.2106/jbjs.i.01794
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发表时间：
2011-10-05
影响因子：
5.3
通讯作者：
Yang, Jae-Hyuk
中科院分区：
文献类型：
--
作者：
Modi, Hitesh N.;Suh, Seung-Woo;Yang, Jae-Hyuk
背景：脊柱短缩引起的脊髓损伤是灾难性的，但脊柱在不损伤的情况下可以缩短的量是未知的。我们评估了脊髓损伤和脊髓血流量的变化后，脊柱shortening in swines.Methods：10只猪进行椎弓根螺钉器械之间的T10和113，然后由T11和T12椎体切除术导致脊柱缩短。分别采用经颅运动诱发电位和激光多普勒血流仪同时监测脊髓功能和脊髓血流。进行了分期缩短手术：第1阶段导致脊髓无形态学变化，第2阶段导致脊髓屈曲，第3阶段导致脊髓扭结。在运动诱发电位信号丢失后，这被认为是脊髓损伤的指示，脊柱器械被收紧。运动诱发电位和脊髓血流量再记录30分钟，然后进行唤醒试验。最后，脊髓标本获得和评价histologic.Results：运动诱发电位数据表明，在第1和第2阶段没有脊髓损伤的证据。然而，信号在第3阶段丢失，表明脊髓损伤。平均短缩为35 +/- 2.7 mm，与胸腰椎节段的平均椎体高度（33.6 +/- 1.9 mm）相似，表明脊髓损伤是由相当于一个椎体高度的短缩引起的。如果缩短量小于整个脊柱的平均节段高度（T1-L 6为27.7 ± 1.6 mm），则脊柱缩短不会造成损伤。脊髓血流量在第2阶段略有增加（增加11.6% +/- 20.6%），但在第3阶段减少43.1% +/- 11.4%。30分钟后进行的唤醒测试显示下肢无运动。结论：胸腰椎水平脊柱缩短≥ 104.2%的一个椎体高度会导致脊髓损伤，但胸腰椎水平脊柱缩短≥ 104.2%的椎体高度会导致脊髓损伤。
Background: Spinal cord injury due to spinal shortening is disastrous, but the amount that the spine can be shortened without injury is unknown. We assessed spinal cord injury and changes in spinal cord blood flow after spinal shortening in swine.Methods: Ten pigs underwent pedicle screw instrumentation between T10 and 113 followed by a T11 and T12 vertebrectomy resulting in spinal shortening. Spinal cord function and spinal cord blood flow were monitored simultaneously with use of transcranial motor evoked potentials and laser Doppler flowmetry, respectively. A staged shortening procedure was performed: phase 1 resulted in no morphological change in the spinal cord, phase 2 resulted in buckling of the spinal cord, and phase 3 resulted in kinking of the spinal cord. After loss of motor evoked potential signals, which was considered to indicate spinal cord injury, the spinal instrumentation was tightened. The motor evoked potentials and spinal cord blood flow were Monitored for an additional thirty minutes, and a wake-up test was then performed. Finally, a spinal cord specimen was obtained and evaluated histologically.Results: The motor evoked potential data demonstrated no evidence of spinal cord injury during phases 1 and 2. However, the signals were lost during phase 3, indicating spinal cord injury. The mean shortening was 35 +/- 2.7 mm, which was similar to the mean vertebral body height at the thoracolumbar level (33.6 +/- 1.9 mm), indicating that spinal cord injury resulted from shortening equivalent to the height of one vertebra. Spinal shortening did not cause injury if the amount of shortening was less than the mean segmental height of the entire spinal column (27.7 +/- 1.6 mm for T1-L6). The spinal cord blood flow increased slightly (by 11.6% +/- 20.6%) during phase 2, but decreased by 43.1% +/- 11.4% during phase 3. The wake-up test performed after thirty minutes revealed no movement in the lower limbs.Conclusions: Spinal shortening of >= 104.2% of one vertebral body height at the thoracolumbar level caused spinal cord injury, but shortening of