Effects on spinal cord blood flow and neurologic function secondary to interruption of bilateral segmental arteries which supply the artery of Adamkiewicz - An experimental study using a dog model
Effects on spinal cord blood flow and neurologic function secondary to interruption of bilateral segmental arteries which supply the artery of Adamkiewicz - An experimental study using a dog model
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DOI：
10.1097/brs.0b013e318178e5af
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发表时间：
2008-06-15
期刊：
影响因子：
3
通讯作者：
Fujimaki, Yoshiyasu
中科院分区：
文献类型：
--
作者：
Kato, Satoshi;Kawahara, Norio;Fujimaki, Yoshiyasu
研究设计.在狗的脊髓中，包括Adamkiewicz动脉水平在内的节段动脉被阻断多达4个水平，以研究对脊髓血流量和神经功能的影响。研究双侧节段动脉结扎（包括Adamkiewicz动脉水平）导致缺血性脊髓功能障碍的情况。在狗模型中，在没有Adamkiewicz动脉水平的情况下，在>= 5个连续水平中断双侧节段动脉有产生缺血性脊髓功能障碍的风险。然而，结扎的影响，包括水平Adamkiewicz动脉尚未阐明。本实验选用25只成年狗，颈动脉起源于L5水平。将15只犬分为5组：假手术组，不结扎;第1组，结扎双侧节段动脉1个节段（L5）;第2组，结扎双侧节段动脉2个节段（L4-L5）;第3组，结扎双侧节段动脉3个节段（L4-L 6）;第4组，结扎双侧节段动脉4个节段（L3-L 6）。激光多普勒血流仪测定L5脊髓节段的脊髓血流量，同时测量脊髓诱发电位和复合肌肉动作电位，直至结扎后10小时。另10只犬于术后1周采用改良的Tarlov评分系统进行神经功能评分，分为2组：3对组，结扎3个节段（L4-L 6）; 4对组，结扎4个节段（L3-L 6）。结扎后10小时，假手术组、第1、2、3和4组的脊髓血流量分别为98.2%、76.1%、66.6%、61.4%和53.5%。在第4组的1/3只犬中观察到脊髓诱发电位和复合肌肉动作电位异常。术后神经系统评价确定3对组中的所有5只犬和4对组中的4只犬均为5级。4对犬中有1只犬为4级。包括Adamkiewicz动脉水平在内的≥ 4个连续节段的双侧节段动脉中断有导致缺血性脊髓功能障碍的风险。
Study Design. Segmental arteries including the level of Adamkiewicz artery were interrupted bilaterally for up to 4 levels to study the effects on spinal cord blood flow and neurologic function in dogs.Objective. To examine how many ligations of bilateral segmental arteries including the level of Adamkiewicz artery cause ischemic spinal cord dysfunction.Summary of Background Data. Interruption of bilateral segmental arteries at >= 5 consecutive levels without the level of Adamkiewicz artery has been reported to risk producing ischemic spinal cord dysfunction in dog model. However, the effects of ligating including the level of Adamkiewicz artery have not been elucidated.Methods. The 25 dogs in which Adamkiewicz artery originated from L5 level were taken in this study. There were 15 dogs divided into 5 groups: sham group, no ligation; group 1, ligation of bilateral segmental arteries at 1 level (L5); group 2, at 2 levels (L4-L5); group 3, at 3 levels (L4-L6); and group 4, at 4 levels (L3-L6). Spinal cord blood flow at the L5 spinal cord segment by laser-Doppler flowmetry, and spinal cord-evoked and compound muscle action potentials were measured simultaneously until 10 hours after ligation. Neurologic function was assessed using a modified Tarlov grading system 1 week after operation in 10 other dogs divided into 2 groups: 3 pairs group, ligation at 3 levels (L4-L6); 4 pairs group, at 4 levels (L3-L6).Results. Spinal cord blood flow was 98.2%, 76.1%, 66.6%, 61.4%, and 53.5% in the sham group, groups 1, 2, 3, and 4, respectively, 10 hours after ligation. Abnormal spinal cord-evoked and compound muscle action potentials were observed in 1 out of 3 dogs in group 4. Postoperative neurologic evaluation identified all 5 dogs in 3 pairs group and 4 in 4 pairs group as having grade 5. There was 1 dog in 4 pairs group that had grade 4.Conclusion. Interruption of bilateral segmental arteries at >= 4 consecutive levels including the level of Adamkiewicz artery risks producing ischemic spinal cord dysfunction.