Utilité de la spectroscopie proche de l'infrarouge intra-opératoire dans le prévention des lésions neurologiques lors de la prise en charge chirurgicale d'une déformation de la colonne vertébrale. Etude préliminaire
Résumé
To date, there is no way to directly and locally monitor
spinal cord (SC) oxygenation to prevent iatrogenic neurological
injury during spine surgery. The aims were to develop and test in vivo
on a pig model a prototype to monitor in real time and intraoperatively
the oxygenation of the SC using near infrared spectroscopy (NIRS)
technology.
Methods: We conducted an animal experiment on a pig. We
performed 4 series of measurements. 1-2) Ear and vertebrae of the
animal in normal condition (baseline, i.e. without any stimulation);
3-4) Vertebrae after induction of hypoxia and tachycardia.
Results: The use of our probe on the ear and on the vertebra in
basic condition allowed us to record heart rate, respiratory rate and
local oxygen saturation similar in both cases and comparable to that
found on the anesthesia monitor. During hypoxia induction, locally
measured oxygen saturation decreases from 100% to 60%. It then
increases again when the hypoxia induction sequence is stopped and
returns to its baseline value. At the same time, an increase in heart
rate was observed in response to hypoxia. After induction of
tachycardia by injection of adrenaline, our prototype was able to
measure an increase in heart rate of 100 bpm to 200 bpm, comparable
to anesthetic monitoring.
Conclusion: We have successfully tested a prototype for real-time
monitoring of SC oxygenation in large animals and its ability to detect
alterations in SC vascularization and oxygenation. This study attests
that NIRS technology is a promising tool for the spine surgeon in the
future.
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