Intraoperative Spinal cord Shear wave Elastography In patients undergoing spinal column shortening for recurrent tethered spinal cord: A novel quantitative metric

Saturday, May 4, 2024

4:31 PM – 4:33 PM CT

Location: S403ab

Presenting Author(s)

Daniel Davidar, MD

Research Fellow
Johns Hopkins University School of Medicine
Baltimore, MD, US

Co-Author(s)

KA

Kimberly Ashayeri, MD

Neurosurgery Spine Fellow
Johns Hopkins University School of Medicine
New York, NY, United States
MB

Meghana Bhimreddy, n/a

Medical Student
Johns Hopkins University School of Medicine, United States
Andrew M. Hersh, B.S.

Medical Student
John Hopkins Medical School
Baltimore, Maryland, United States
Kelly Jiang, n/a

Medical Student
Johns Hopkins University School of Medicine
Baltimore, Maryland, United States
MK

Max Kerensky, BS

Student
Johns Hopkins, United States
Arjun K. K. Menta, BSA, BBA (he/him/his)

Medical Student
Johns Hopkins University School of Medicine, United States
DR

Denis Routkevitch, BS

Medical Student
Johns Hopkins, United States
Nicholas Theodore, MD, MS (he/him/his)

Director, Neurosurgical Spine Center; Professor of Neurosurgery
Johns Hopkins University School of Medicine
Baltimore, Maryland, United States
VV

Vikas Vattipally, BA

Medical Student
Department of Neurosurgery, The Johns Hopkins University School of Medicine, United States
Carly Weber-Levine, MS (she/her/hers)

Medical Student
Johns Hopkins University School of Medicine
East Setauket, New York, United States

Introduction: Current diagnosis of tethered spinal cord remains confined to radiological imaging and clinical presentation. In patients requiring de-tethering or spinal column shortening, there is no metric to represent adequate tension relief. In this study, we use novel shear wave elastography to monitor vertebral column shortening.

Methods: Patients were selected prospectively in a single center prospective review between January 2022 to December 2022. Inclusion criteria were patients undergoing spinal column shortening with tethered cord syndrome. Intraoperatively, the surgical site was filled with PBS saline as a buffer. A Canon i18LX5 probe was used in sagittal plane to visualize the central canal. 3-6 shear wave images were taken pre and post shortening. Images were analyzed by an independent radiologist. Datapoints were selected across each point on the spinal cord and shear wave velocity (SWV) collected for each point. In order to standardize variability between spinal cords, SWV was related to tension from the microstructures based on Brieg’s 1972 stains

Results: 6 cases fit the inclusion criteria. The average age of patients was 41.67 ± 5.2 years, BMI was 26.04 ± 5.9 kg/m2. A to tal of 55 images were taken. Average SWV of pre across the 6 cases were 2.36 m/s, 2.1 m/s, 1.79 m/s, 1.98 m/s, 1.9 m/s, and 2.04 m/s. Average SWV of post images were 1.54 m/s, 1.70 m/s, 1.62 m/s, 1.95 m/s, 1.97 m/s and 1.86 m/s. A significant difference was found between in SWV between pre and post images of each case (p < 0.001)

Conclusion : Shear wave elastography can provide a quantitative metric which can be used to determine spinal cord tension. Furthermore, adequate de-tethering or spinal column shortening can be determined by shear wave elastography.