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Perioperative shear wave elastography for the evaluation of spinal cord release in pediatric dysraphism: first
Mathilde Gaume1, Lou Richard1, Claudio Vergari2
11University Institute for Spine Surgery, Armand Trousseau Hospital, Sorbonne Université, Paris.
Insights
Intraoperative shear wave elastography (SWE) is a feasible method for assessing spinal cord stiffness in spinal dysraphism surgery. This technique shows reduced stiffness after detethering, aiding surgical assessment.
Area of Science:
- Neurosurgery
- Medical Imaging
- Biophysics
Background:
- Spinal dysraphism can lead to tethered cord syndrome, causing significant neurological deficits.
- Surgical detethering is crucial for managing spinal cord tension and improving function.
- Shear wave elastography (SWE) offers a non-invasive method to measure tissue stiffness, but its spinal cord application is challenging.
Purpose of the Study:
- To evaluate the feasibility and safety of intraoperative shear wave elastography (SWE) for guiding spinal cord detethering surgery in patients with spinal dysraphism.
- To assess changes in spinal cord stiffness before and after surgical release using SWE.
- To determine if SWE can aid in evaluating the adequacy of spinal cord untethering.
Main Methods:
- A single-center retrospective study involving 21 patients undergoing surgery for spinal dysraphism.
- Intraoperative SWE was performed using the Aixplorer system under general anesthesia before and after spinal cord detethering.
- Demographic, clinical, and radiological data were collected, alongside SWE measurements of spinal cord stiffness.
Main Results:
- Twenty-one pediatric patients with various spinal dysraphism etiologies were included.
- High-quality SWE measurements were obtained in 85% of patients both pre- and post-detethering.
- Mean spinal cord stiffness significantly decreased from 25.2 kPa to 11.2 kPa after detethering (p = 0.018), with no SWE-related complications.
Conclusions:
- Intraoperative SWE of the spinal cord is safe and feasible in patients with spinal dysraphism.
- The technique shows potential to assist in assessing the completeness of spinal cord untethering.
- The lack of established normative pediatric spinal cord SWE values currently limits intraoperative interpretation and clinical utility.
Objective:
Shear wave elastography (SWE) is a recent method for evaluating soft tissue stiffness. Its application to the spinal cord is limited by the ultrasound bone barrier. Spinal dysraphism can cause neurological symptoms impairing bladder, bowel, and lower limb function due to a mechanical stress known as tethered cord syndrome. Detethering of the spinal cord is a part of surgical treatment. This study aimed to assess the feasibility of intraoperative elastography to guide surgery in patients with spinal dysraphism involving traction of the spinal cord.
Methods:
This single-center retrospective study included all patients who underwent surgery for spinal dysraphism between November 2023 and July 2024. SWE was performed under general anesthesia with the patient in the prone position before and after spinal cord detethering. All SWE measurements were performed using the Aixplorer system. Demographic, clinical, and radiological data (age at surgery, neurological status, and MRI findings) were collected.
Results:
Twenty-one patients with a mean ± SD (range) age of 3.7 ± 5.3 (0-17.5) years were included. Etiologies included open saccular dysraphism (n = 3), spinal cord conus lipoma (n = 6), limited dorsal myeloschisis (n = 3), and fibrolipomatous filum (n = 9). In 85% of patients, at least 1 clip was of sufficient quality for analysis both before and after release. The mean ± SD (range) spinal cord stiffness at the beginning of surgery was 25.2 ± 9.2 (12.3-39.1) kPa and 11.2 ± 3.8 (6.2-16.5) kPa at the end of release, with a significant stiffness decrease (p = 0.018). No complications attributable to SWE were observed.
Conclusions:
SWE of the spinal cord in patients with spinal dysraphism is a safe and feasible imaging method. This technique may assist in assessing the adequacy of untethering during surgery. However, no established normative SWE values for the pediatric spinal cord currently exist. Until it does, the intraoperative interpretability and clinical utility of this technique remain limited.
