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

Najmeh Kheram; Andrea Boraschi; José Aguirre; Mazda Farshad; Nikolai Pfender; Armin Curt; Martin Schubert; Vartan Kurtcuoglu; Carl M Zipser

doi:10.1016/j.jocn.2024.110803

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

J Clin Neurosci. 2024 Oct:128:110803. doi: 10.1016/j.jocn.2024.110803. Epub 2024 Aug 19.

Authors

Najmeh Kheram¹, Andrea Boraschi², José Aguirre³, Mazda Farshad⁴, Nikolai Pfender⁵, Armin Curt⁵, Martin Schubert⁵, Vartan Kurtcuoglu², Carl M Zipser⁶

Affiliations

¹ Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland; University Spine Center, Balgrist University Hospital, Zurich, Switzerland; Institute of Physiology, University of Zurich, Zurich, Switzerland.
² Institute of Physiology, University of Zurich, Zurich, Switzerland.
³ University Spine Center, Balgrist University Hospital, Zurich, Switzerland; Department of Anesthesiology, Balgrist University Hospital, Zurich, Switzerland.
⁴ University Spine Center, Balgrist University Hospital, Zurich, Switzerland.
⁵ Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland; University Spine Center, Balgrist University Hospital, Zurich, Switzerland.
⁶ Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland; University Spine Center, Balgrist University Hospital, Zurich, Switzerland. Electronic address: carlmoritz.zipser@balgrist.ch.

PMID: 39163699
DOI: 10.1016/j.jocn.2024.110803

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 pCO₂ 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.

Keywords: Cerebrospinal fluid pressure; Degenerative cervical myelopathy; Spinal cord compression; Spinal cord injury.

MeSH terms

Adult
Aged
Cerebrospinal Fluid Pressure* / physiology
Cervical Vertebrae / surgery
Cohort Studies
Decompression, Surgical* / methods
Female
Humans
Male
Middle Aged
Postoperative Period
Retrospective Studies