Cerebrospinal fluid pressure dynamics as a biomechanical marker for quantification of spinal cord compression: Conceptual framework and systematic review of clinical trials
Introduction: In patients with acute spinal cord injury (SCI) and degenerative cervical myelopathy (DCM), spinal cord compression is considered a main contributor to spinal cord damage, associated with cerebrospinal fluid (CSF) space obstruction. CSF pressure (CSFP) dynamics are studied as a potenti...
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| Format: | Article |
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Elsevier
2025-01-01
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| Series: | Brain and Spine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S277252942500030X |
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| author | Najmeh Kheram Madeleine A. Bessen Claire F. Jones Benjamin M. Davies Mark Kotter Mazda Farshad Markus Hupp Daniel Nanz Patrick Freund Martin Schubert Vartan Kurtcuoglu Armin Curt Carl M. Zipser |
| author_facet | Najmeh Kheram Madeleine A. Bessen Claire F. Jones Benjamin M. Davies Mark Kotter Mazda Farshad Markus Hupp Daniel Nanz Patrick Freund Martin Schubert Vartan Kurtcuoglu Armin Curt Carl M. Zipser |
| author_sort | Najmeh Kheram |
| collection | DOAJ |
| description | Introduction: In patients with acute spinal cord injury (SCI) and degenerative cervical myelopathy (DCM), spinal cord compression is considered a main contributor to spinal cord damage, associated with cerebrospinal fluid (CSF) space obstruction. CSF pressure (CSFP) dynamics are studied as a potential indirect biomechanical marker for spinal cord compression, and as a proxy to estimate spinal cord perfusion pressure (SCPP). Research question: Evidence for safety and feasibility of CSFP dynamics in clinical trials as well as interrelations with neuroimaging and intraspinal pressure, and relation to preclinical CSFP models. Material and methods: Systematic review. This review followed PRISMA guidelines, risk of bias assessment with ROBINS-I tool, PROSPERO registration (CRD42024545629). Results: 11 relevant papers were identified (n = 212 patients, n = 194 intraoperative, n = 18 bedside). Risk of bias for safety reporting was low-moderate. Intraoperative CSFP assessments were commonly performed in acute SCI. CSFP was assessed to calculate SCPP (7/11), to evaluate effects from surgical decompression (5/11) and for therapeutic CSF drainage (3/11). The adverse event rate associated with the intrathecal catheter was 8% (n = 15/194). Discussion and conclusion: The preliminary safety and feasibility profile of CSFP assessments in spinal cord compression encourages clinical application. However, a deeper risk-benefit analysis is limited as the clinical value is not yet determined, given challenges of defining disease specific critical CSFP and SCPP thresholds. The interrelation between measures of CSFP and neuroimaging is yet to be proven. Targeted preclinical studies are essential to improve our understanding of complex CSFP-cord compression interrelations. |
| format | Article |
| id | doaj-art-ef40be5538d648769e350dbf840ac16b |
| institution | DOAJ |
| issn | 2772-5294 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brain and Spine |
| spelling | doaj-art-ef40be5538d648769e350dbf840ac16b2025-08-20T03:00:49ZengElsevierBrain and Spine2772-52942025-01-01510421110.1016/j.bas.2025.104211Cerebrospinal fluid pressure dynamics as a biomechanical marker for quantification of spinal cord compression: Conceptual framework and systematic review of clinical trialsNajmeh Kheram0Madeleine A. Bessen1Claire F. Jones2Benjamin M. Davies3Mark Kotter4Mazda Farshad5Markus Hupp6Daniel Nanz7Patrick Freund8Martin Schubert9Vartan Kurtcuoglu10Armin Curt11Carl M. Zipser12Spinal Cord Injury Center and Department of Neurology and Neurophysiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland; University Spine Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland; The Interface Group, Institute of Physiology, University of Zurich, Zurich, SwitzerlandAdelaide Medical School, The University of Adelaide, Adelaide, AustraliaSchool of Electrical & Mechanical Engineering, The University of Adelaide, Adelaide, AustraliaDepartment of Neurosurgery, University of Cambridge, Cambridge, United KingdomDepartment of Neurosurgery, University of Cambridge, Cambridge, United KingdomUniversity Spine Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland; Department of Spine Surgery, Balgrist University Hospital, University of Zurich, Zurich, SwitzerlandSpinal Cord Injury Center and Department of Neurology and Neurophysiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland; University Spine Center, Balgrist University Hospital, University of Zurich, Zurich, SwitzerlandSwiss Center for Musculoskeletal Imaging, Balgrist Campus AG, Zurich, Switzerland; Medical Faculty, University of Zurich, Zurich, SwitzerlandSpinal Cord Injury Center and Department of Neurology and Neurophysiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland; University Spine Center, Balgrist University Hospital, University of Zurich, Zurich, SwitzerlandSpinal Cord Injury Center and Department of Neurology and Neurophysiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland; University Spine Center, Balgrist University Hospital, University of Zurich, Zurich, SwitzerlandThe Interface Group, Institute of Physiology, University of Zurich, Zurich, Switzerland; Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, SwitzerlandSpinal Cord Injury Center and Department of Neurology and Neurophysiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland; University Spine Center, Balgrist University Hospital, University of Zurich, Zurich, SwitzerlandSpinal Cord Injury Center and Department of Neurology and Neurophysiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland; University Spine Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland; Corresponding author. Spinal Cord Injury Center and Department of Neurology and Neurophysiology, Balgrist University Hospital, Zurich, Switzerland.Introduction: In patients with acute spinal cord injury (SCI) and degenerative cervical myelopathy (DCM), spinal cord compression is considered a main contributor to spinal cord damage, associated with cerebrospinal fluid (CSF) space obstruction. CSF pressure (CSFP) dynamics are studied as a potential indirect biomechanical marker for spinal cord compression, and as a proxy to estimate spinal cord perfusion pressure (SCPP). Research question: Evidence for safety and feasibility of CSFP dynamics in clinical trials as well as interrelations with neuroimaging and intraspinal pressure, and relation to preclinical CSFP models. Material and methods: Systematic review. This review followed PRISMA guidelines, risk of bias assessment with ROBINS-I tool, PROSPERO registration (CRD42024545629). Results: 11 relevant papers were identified (n = 212 patients, n = 194 intraoperative, n = 18 bedside). Risk of bias for safety reporting was low-moderate. Intraoperative CSFP assessments were commonly performed in acute SCI. CSFP was assessed to calculate SCPP (7/11), to evaluate effects from surgical decompression (5/11) and for therapeutic CSF drainage (3/11). The adverse event rate associated with the intrathecal catheter was 8% (n = 15/194). Discussion and conclusion: The preliminary safety and feasibility profile of CSFP assessments in spinal cord compression encourages clinical application. However, a deeper risk-benefit analysis is limited as the clinical value is not yet determined, given challenges of defining disease specific critical CSFP and SCPP thresholds. The interrelation between measures of CSFP and neuroimaging is yet to be proven. Targeted preclinical studies are essential to improve our understanding of complex CSFP-cord compression interrelations.http://www.sciencedirect.com/science/article/pii/S277252942500030XCerebrospinal fluid pressure dynamicsSpinal cord compressionSpinal cord injuryDegenerative cervical myelopathy |
| spellingShingle | Najmeh Kheram Madeleine A. Bessen Claire F. Jones Benjamin M. Davies Mark Kotter Mazda Farshad Markus Hupp Daniel Nanz Patrick Freund Martin Schubert Vartan Kurtcuoglu Armin Curt Carl M. Zipser Cerebrospinal fluid pressure dynamics as a biomechanical marker for quantification of spinal cord compression: Conceptual framework and systematic review of clinical trials Brain and Spine Cerebrospinal fluid pressure dynamics Spinal cord compression Spinal cord injury Degenerative cervical myelopathy |
| title | Cerebrospinal fluid pressure dynamics as a biomechanical marker for quantification of spinal cord compression: Conceptual framework and systematic review of clinical trials |
| title_full | Cerebrospinal fluid pressure dynamics as a biomechanical marker for quantification of spinal cord compression: Conceptual framework and systematic review of clinical trials |
| title_fullStr | Cerebrospinal fluid pressure dynamics as a biomechanical marker for quantification of spinal cord compression: Conceptual framework and systematic review of clinical trials |
| title_full_unstemmed | Cerebrospinal fluid pressure dynamics as a biomechanical marker for quantification of spinal cord compression: Conceptual framework and systematic review of clinical trials |
| title_short | Cerebrospinal fluid pressure dynamics as a biomechanical marker for quantification of spinal cord compression: Conceptual framework and systematic review of clinical trials |
| title_sort | cerebrospinal fluid pressure dynamics as a biomechanical marker for quantification of spinal cord compression conceptual framework and systematic review of clinical trials |
| topic | Cerebrospinal fluid pressure dynamics Spinal cord compression Spinal cord injury Degenerative cervical myelopathy |
| url | http://www.sciencedirect.com/science/article/pii/S277252942500030X |
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