Intraoperative Monitoring of CSF Pressure in Patients with Degenerative Cervical Myelopathy (COMP-CORD Study): A Prospective Cohort Study

Zipser, Carl Moritz; Pfender, Nikolai; Kheram, Najmeh; Boraschi, Andrea; Aguirre, José; Ulrich, Nils H.; Spirig, José Miguel; Ansorge, Alexandre; Betz, Michael; Wanivenhaus, Florian; Hupp, Markus; Kurtcuoglu, Vartan; Farshad, Mazda; Curt, Armin; Schubert, Martin

doi:10.1089/neu.2021.0310

Cited by 7 publications

(2 citation statements)

References 39 publications

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“…Beyond the CSF opening pressure, continuous high-resolution recording enables the measurement of CSFP amplitude variations induced by cardiovascular action (CSFPp). While this has been investigated in selected cohorts of patients suffering from various disorders at bedside (e.g., in intracranial hypertension [ 5 ] and Chiari malformation [ 16 ]) or intraoperatively (e.g., in syringomyelia [ 35 ], spinal cord injury [ 29 ], and degenerative cervical myelopathy; DCM [ 48 ]), lumbar CSFPp in healthy subjects are rather poorly studied. In 10 patients without intracranial pathology, an average CSFPp of 0.7 mmHg was observed [ 43 ], and another study reported an average lumbar CSFPp of 2.0 mmHg in 40 healthy elderly volunteers [ 25 ].…”

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confidence: 99%

Queckenstedt’s test repurposed for the quantitative assessment of the cerebrospinal fluid pulsatility curve

et al. 2023

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Purpose Before the era of spinal imaging, presence of a spinal canal block was tested through gross changes in cerebrospinal fluid pressure (CSFP) provoked by manual compression of the jugular veins (referred to as Queckenstedt's test; QT). Beyond these provoked gross changes, cardiac-driven CSFP peak-to-valley amplitudes (CSFPp) can be recorded during CSFP registration. This is the first study to assess whether the QT can be repurposed to derive descriptors of the CSF pulsatility curve, focusing on feasibility and repeatability. Method Lumbar puncture was performed in lateral recumbent position in fourteen elderly patients (59.7±9.3 years, 6F) (NCT02170155) without stenosis of the spinal canal. CSFP was recorded during resting state and QT. A surrogate for the relative pulse pressure coefficient was computed from repeated QTs (i.e., RPPC-Q). Results Resting state mean CSFP was 12.3 mmHg (IQR 3.2) and CSFPp was 1.0 mmHg (0.5). Mean CSFP rise during QT was 12.5 mmHg (7.3). CSFPp showed an average 3-fold increase at peak QT compared to the resting state. Median RPPC-Q was 0.18 (0.04). There was no systematic error in the computed metrics between the first and second QT. Conclusion This technical note describes a method to reliably derive, beyond gross CSFP increments, metrics related to cardiac-driven amplitudes during QT (i.e., RPPC-Q). A study comparing these metrics as obtained by established procedures (i.e., infusion testing) and by QT is warranted.

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Section: Introductionmentioning

confidence: 99%

Queckenstedt’s test repurposed for the quantitative assessment of the cerebrospinal fluid pulsatility curve

et al. 2023

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“…For this purpose, we aim at exploring the utility of CSFP assessments in ambiguous cases of DCM. Previously, we have provided evidence that intraoperative CSFP dynamics are responsive to surgical decompression ( 18 ). For bedside testing, we hypothesized that CSFP dynamics would allow to determine effective spinal obstruction in these ambiguous DCM cases.…”

Section: Introductionmentioning

confidence: 99%

Cerebrospinal fluid pressure dynamics reveal signs of effective spinal canal narrowing in ambiguous spine conditions

et al. 2022

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Spinal canal narrowing with consecutive spinal cord compression is considered a key mechanism in degenerative cervical myelopathy (DCM). DCM is a common spine condition associated with progressive neurological disability, and timely decompressive surgery is recommended. However, the clinical and radiological diagnostic workup is often ambiguous, challenging confident proactive treatment recommendations. Cerebrospinal fluid pressure dynamics (CSFP) are altered by spinal canal narrowing. Therefore, we aim to explore the potential value of bedside CSFP assessments for qualitative and quantitative assessment of spinal canal narrowing in DCM. In this prospective case series, seven patients with DCM underwent bedside lumbar puncture with measurement of CSFP dynamics and routine CSF analysis (NCT02170155). The patients were enrolled when standard diagnostic algorithms did not permit a clear treatment decision. Measurements include baseline CSFP, cardiac-driven CSFP peak-to-trough amplitude (CSFPp), and the Queckenstedt's test (firm pressure on jugular veins) in neutral and reclined head position. From the Queckenstedt's test, proxies for craniospinal elastance (i.e., relative pulse pressure coefficient; RPPC-Q) were calculated analogously to infusion testing. CSFP metrics were deemed suspicious of canal narrowing when numbers were lower than the minimum value from a previously tested elderly spine-healthy cohort (N = 14). Mean age was 56 ± 13 years (range, 38–75; 2F); symptom severity was mostly mild to moderate (mean mJOA, 13.5 ± 2.6; range, 9–17). All the patients showed some extent of cervical stenosis in the MRI of unclear significance (5/7 following decompressive cervical spine surgery with an adjacent level or residual stenosis). Baseline CSFP was normal except for one patient (range, 4.7–17.4 mmHg). Normal values were found for CSFPp (0.4–1.3 mmHg) and the Queckenstedt's test in normal head positioning (9.-25.3 mmHg). During reclination, the Queckenstedt's test significantly decreased in one, and CSFPp in another case (>50% compared to normal position). RPPC-Q (0.07–0.19) aligned with lower values from spine-healthy (0.10–0.44). Routine CSF examinations showed mild total protein elevation (mean, 522 ± 108 mg/ml) without further evidence for the disturbed blood brain barrier. Intrathecal CSFP measurements allow discerning disturbed from normal CSFP dynamics in this population. Prospective longitudinal studies should further evaluate the diagnostic utility of CSFP assessments in DCM.

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State of the art and future directions of degenerative cervical myelopathy

Pedro,

Hejrati,

Fehlings

2023

Degenerative Cervical Myelopathy

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Intraoperative Monitoring of CSF Pressure in Patients with Degenerative Cervical Myelopathy (COMP-CORD Study): A Prospective Cohort Study

Cited by 7 publications

References 39 publications

Queckenstedt’s test repurposed for the quantitative assessment of the cerebrospinal fluid pulsatility curve

Queckenstedt’s test repurposed for the quantitative assessment of the cerebrospinal fluid pulsatility curve

Cerebrospinal fluid pressure dynamics reveal signs of effective spinal canal narrowing in ambiguous spine conditions

State of the art and future directions of degenerative cervical myelopathy

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