Evaluating the efficacy of intraoperative NIRS cutoff values in detecting spinal cord ischemia during surgery.

IF 2.2 3区医学 Q2 ANESTHESIOLOGY

Journal of Clinical Monitoring and Computing Pub Date : 2025-07-22 DOI:10.1007/s10877-025-01331-w

Sebastian Zinn, Nia Joseph, Travis Stanley CreveCoeur, Roman M Sniecinski, Paul S García

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引用次数: 0

Abstract

Purpose: Paralysis is a serious complication of surgeries that interferes with the blood supply of the anterior spinal cord, with rates of spinal cord injury (SCI) from approximately 1% in general spine surgeries to 4-40% following thoracoabdominal aortic aneurysm (TAAA) repair. Near-infrared spectroscopy (NIRS) provides a non-invasive, real-time method for monitoring tissue oxygenation, largely unaffected by anesthetics. Given the heightened risk of neurologic injury during TAAA repair, this procedure is used to evaluate the effectiveness of standard regional spinal oxygen saturation (rSpO₂) cutoff values in predicting neurological outcomes.

Methods: This retrospective study analyzed 25 patients undergoing open TAAA repair. NIRS data were recorded at the ischemic site and a reference location throughout surgery. Neurological outcomes were assessed postoperatively based on paralysis, hemiparesis, or extremity weakness. After excluding eight patients due to poor signal quality, 17 patients were included. NIRS values at six key time points were compared between outcome groups. Bayesian statistics assessed the relationship between significant NIRS "drops" (< 80% of baseline) and neurological outcomes.

Results: Seven patients exhibited new neurological deficits (4 temporary). No credible association was found between intraoperative NIRS drops and postoperative neurological outcomes at any analyzed time point. A moderate effect was observed at the end of surgery (Hedges' g = - 1.21), suggesting a potential difference between groups, although the Bayesian credible interval included zero (posterior mean = - 0.82, 94% HDI [- 1.8, 0.18]).

Conclusions: In this limited cohort, intraoperative NIRS cutoff values did not significantly correlate with postoperative neurological deficits following TAAA repair. Postoperative NIRS monitoring may be more informative for detecting spinal cord ischemia and preventing paralysis.

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评价术中NIRS截止值检测术中脊髓缺血的效果。

目的：麻痹是手术的严重并发症，它干扰脊髓前段的血液供应，脊髓损伤（SCI）的发生率从一般脊柱手术的约1%上升到胸腹主动脉瘤（TAAA）修复后的4-40%。近红外光谱（NIRS）提供了一种非侵入性的实时监测组织氧合的方法，在很大程度上不受麻醉剂的影响。考虑到TAAA修复过程中神经损伤的风险增加，该程序用于评估标准区域脊髓氧饱和度（rSpO₂）临界值在预测神经预后方面的有效性。方法：回顾性分析25例行开放性TAAA修补术的患者。在整个手术过程中，在缺血部位和参考位置记录近红外光谱数据。术后神经系统预后以麻痹、偏瘫或四肢无力为基础进行评估。因信号质量差而剔除8例患者后，纳入17例患者。比较结果组间6个关键时间点的NIRS值。贝叶斯统计评估了显著NIRS“下降”之间的关系(结果：7例患者出现新的神经功能障碍（4例是暂时性的）。在任何分析的时间点上，术中NIRS下降与术后神经预后之间没有可信的关联。在手术结束时观察到中度效果（Hedges' g = - 1.21），尽管贝叶斯可信区间为零（后验均值= - 0.82,94% HDI[- 1.8, 0.18]），但这表明两组之间存在潜在差异。结论：在这个有限的队列中，术中NIRS截止值与TAAA修复后的术后神经功能缺损无显著相关性。术后近红外光谱监测对于发现脊髓缺血和预防瘫痪可能提供更多信息。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Monitoring and Computing ANESTHESIOLOGY-

CiteScore

4.30

自引率

13.60%

发文量

144

审稿时长

6-12 weeks

期刊介绍： The Journal of Clinical Monitoring and Computing is a clinical journal publishing papers related to technology in the fields of anaesthesia, intensive care medicine, emergency medicine, and peri-operative medicine. The journal has links with numerous specialist societies, including editorial board representatives from the European Society for Computing and Technology in Anaesthesia and Intensive Care (ESCTAIC), the Society for Technology in Anesthesia (STA), the Society for Complex Acute Illness (SCAI) and the NAVAt (NAVigating towards your Anaestheisa Targets) group. The journal publishes original papers, narrative and systematic reviews, technological notes, letters to the editor, editorial or commentary papers, and policy statements or guidelines from national or international societies. The journal encourages debate on published papers and technology, including letters commenting on previous publications or technological concerns. The journal occasionally publishes special issues with technological or clinical themes, or reports and abstracts from scientificmeetings. Special issues proposals should be sent to the Editor-in-Chief. Specific details of types of papers, and the clinical and technological content of papers considered within scope can be found in instructions for authors.