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Bessen MA, Gayen CD, Quarrington RD, Walls AC, Leonard AV, Kurtcuoglu V, Jones CF. Characterising spinal cerebrospinal fluid flow in the pig with phase-contrast magnetic resonance imaging. Fluids Barriers CNS 2023; 20:5. [PMID: 36653870 PMCID: PMC9850564 DOI: 10.1186/s12987-022-00401-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/13/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Detecting changes in pulsatile cerebrospinal fluid (CSF) flow may assist clinical management decisions, but spinal CSF flow is relatively understudied. Traumatic spinal cord injuries (SCI) often cause spinal cord swelling and subarachnoid space (SAS) obstruction, potentially causing pulsatile CSF flow changes. Pigs are emerging as a favoured large animal SCI model; therefore, the aim of this study was to characterise CSF flow along the healthy pig spine. METHODS Phase-contrast magnetic resonance images (PC-MRI), retrospectively cardiac gated, were acquired for fourteen laterally recumbent, anaesthetised and ventilated, female domestic pigs (22-29 kg). Axial images were obtained at C2/C3, T8/T9, T11/T12 and L1/L2. Dorsal and ventral SAS regions of interest (ROI) were manually segmented. CSF flow and velocity were determined throughout a cardiac cycle. Linear mixed-effects models, with post-hoc comparisons, were used to identify differences in peak systolic/diastolic flow, and maximum velocity (cranial/caudal), across spinal levels and dorsal/ventral SAS. Velocity wave speed from C2/C3 to L1/L2 was calculated. RESULTS PC-MRI data were obtained for 11/14 animals. Pulsatile CSF flow was observed at all spinal levels. Peak systolic flow was greater at C2/C3 (dorsal: - 0.32 ± 0.14 mL/s, ventral: - 0.15 ± 0.13 mL/s) than T8/T9 dorsally (- 0.04 ± 0.03 mL/s; p < 0.001), but not different ventrally (- 0.08 ± 0.08 mL/s; p = 0.275), and no difference between thoracolumbar levels (p > 0.05). Peak diastolic flow was greater at C2/C3 (0.29 ± 0.08 mL/s) compared to T8/T9 (0.03 ± 0.03 mL/s, p < 0.001) dorsally, but not different ventrally (p = 1.000). Cranial and caudal maximum velocity at C2/C3 were greater than thoracolumbar levels dorsally (p < 0.001), and T8/T9 and L1/L2 ventrally (p = 0.022). Diastolic velocity wave speed was 1.41 ± 0.39 m/s dorsally and 1.22 ± 0.21 m/s ventrally, and systolic velocity wave speed was 1.02 ± 0.25 m/s dorsally and 0.91 ± 0.22 m/s ventrally. CONCLUSIONS In anaesthetised and ventilated domestic pigs, spinal CSF has lower pulsatile flow and slower velocity wave propagation, compared to humans. This study provides baseline CSF flow at spinal levels relevant for future SCI research in this animal model.
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Affiliation(s)
- Madeleine Amy Bessen
- grid.1010.00000 0004 1936 7304Adelaide Spinal Research Group and Centre for Orthopaedics and Trauma Research, Adelaide Medical School, The University of Adelaide, Level 7, Adelaide Health and Medical Sciences Building, The University of Adelaide, North Terrace, Adelaide, SA 5005 Australia
| | - Christine Diana Gayen
- grid.1010.00000 0004 1936 7304Adelaide Spinal Research Group and Centre for Orthopaedics and Trauma Research, Adelaide Medical School, The University of Adelaide, Level 7, Adelaide Health and Medical Sciences Building, The University of Adelaide, North Terrace, Adelaide, SA 5005 Australia ,grid.1010.00000 0004 1936 7304Translational Neuropathology Laboratory, School of Biomedicine, The University of Adelaide, Level 2, Helen Mayo North Building, The University of Adelaide, Frome Road, Adelaide, SA 5005 Australia
| | - Ryan David Quarrington
- grid.1010.00000 0004 1936 7304Adelaide Spinal Research Group and Centre for Orthopaedics and Trauma Research, Adelaide Medical School, The University of Adelaide, Level 7, Adelaide Health and Medical Sciences Building, The University of Adelaide, North Terrace, Adelaide, SA 5005 Australia ,grid.1010.00000 0004 1936 7304School of Electrical and Mechanical Engineering, The University of Adelaide, North Terrace, Adelaide, SA 5005 Australia
| | - Angela Catherine Walls
- grid.430453.50000 0004 0565 2606Clinical and Research Imaging Centre, South Australian Health and Medical Research Institute, National Imaging Facility, Northern Pod, SAHMRI, North Terrace, Adelaide, SA 5000 Australia
| | - Anna Victoria Leonard
- grid.1010.00000 0004 1936 7304Translational Neuropathology Laboratory, School of Biomedicine, The University of Adelaide, Level 2, Helen Mayo North Building, The University of Adelaide, Frome Road, Adelaide, SA 5005 Australia
| | - Vartan Kurtcuoglu
- grid.7400.30000 0004 1937 0650Institute of Physiology, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland ,grid.7400.30000 0004 1937 0650Zurich Center for Integrative Human Physiology, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland ,grid.7400.30000 0004 1937 0650Neuroscience Center Zurich, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Claire Frances Jones
- grid.1010.00000 0004 1936 7304Adelaide Spinal Research Group and Centre for Orthopaedics and Trauma Research, Adelaide Medical School, The University of Adelaide, Level 7, Adelaide Health and Medical Sciences Building, The University of Adelaide, North Terrace, Adelaide, SA 5005 Australia ,grid.1010.00000 0004 1936 7304School of Electrical and Mechanical Engineering, The University of Adelaide, North Terrace, Adelaide, SA 5005 Australia ,grid.416075.10000 0004 0367 1221Department of Orthopaedics, Royal Adelaide Hospital, Adelaide, SA 5000 Australia
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Kim HJ, Kim H, Kim YT, Sohn CH, Kim K, Kim DJ. Cerebrospinal fluid dynamics correlate with neurogenic claudication in lumbar spinal stenosis. PLoS One 2021; 16:e0250742. [PMID: 33979373 PMCID: PMC8115821 DOI: 10.1371/journal.pone.0250742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/12/2021] [Indexed: 11/18/2022] Open
Abstract
Neurogenic claudication is a typical manifestation of lumbar spinal stenosis (LSS). However, its pathophysiology is still unclear. The severity of clinical symptoms has been shown not to correlate with the degree of structural stenosis. Altered cerebrospinal fluid (CSF) flow has been suggested as one of the causative factors of LSS. The objectives of this study were to compare CSF dynamics at the lumbosacral level between patients with LSS and healthy controls and to investigate whether CSF dynamics parameters explain symptom severity in LSS. Phase-contrast magnetic resonance imaging (PC-MRI) was conducted to measure CSF dynamics in 18 healthy controls and 9 patients with LSS. Cephalic peak, caudal peak, and peak-to-peak CSF velocities were evaluated at the lumbosacral level in the patients and controls. The power of CSF dynamics parameters to predict symptom severity was determined using a linear regression analysis adjusted for demographic and structural variables. Significantly attenuated CSF flow velocity was observed in the patients compared with the controls. The cephalic peak, caudal peak, and peak-to-peak velocities at the lumbar level were greater in the controls than in the patients (p<0.001). The predictive power increased most when the peak-to-peak velocity was added (adjusted R2 = 0.410) to the model with age, body mass index, and the minimum anterior-posterior diameter (adjusted R2 = 0.306), and the peak-to-peak velocity was the only statistically significant variable. CSF dynamics variables showed an association with the severity of LSS symptoms, independent of structural stenosis. PC-MRI can help to further our understanding of the pathophysiology of neurogenic claudication and support the diagnosis of LSS.
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Affiliation(s)
- Hyun-Ji Kim
- Department of Brain and Cognitive Engineering, Korea University, Seoul, South Korea
| | - Hakseung Kim
- Department of Brain and Cognitive Engineering, Korea University, Seoul, South Korea
| | - Young-Tak Kim
- Department of Brain and Cognitive Engineering, Korea University, Seoul, South Korea
| | - Chul-Ho Sohn
- Department of Radiology, Seoul National University Hospital, College of Medicine, Seoul, South Korea
| | - Keewon Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital, College of Medicine, Seoul, South Korea
- * E-mail: (DJK); (KK)
| | - Dong-Joo Kim
- Department of Brain and Cognitive Engineering, Korea University, Seoul, South Korea
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
- * E-mail: (DJK); (KK)
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Elevated Mitochondrial Reactive Oxygen Species within Cerebrospinal Fluid as New Index in the Early Detection of Lumbar Spinal Stenosis. Diagnostics (Basel) 2021; 11:diagnostics11050748. [PMID: 33922090 PMCID: PMC8143471 DOI: 10.3390/diagnostics11050748] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/14/2021] [Accepted: 04/20/2021] [Indexed: 01/08/2023] Open
Abstract
Lumbar spinal stenosis (LSS) is a common neurodegenerative condition. However, how neurogenic claudication develops with severe leg pain has not yet been clearly elucidated. Moreover, cerebrospinal fluid (CSF) physiology at the lumbosacral level is poorly understood because of the difficulties involved in quantification and visualization. Recent studies have suggested that assessment of mitochondrial function in CSF provides an indirect way to assess neurological disorders and an important feature of disease progression. In this study, we assessed the relevance of endogenous extracellular mitochondria in the CSF of rats after LSS. Mitochondrial changes within the CSF were analyzed following LSS at 1 week using flow cytometry. An increase in cell size and number was observed in CSF with LSS, and reactive oxygen species (ROS) levels were also increased within the CSF at 1 week in the LSS group. Elevated mitochondrial ROS and functional changes in the CSF are hallmarks of LSS. The present study is the first to demonstrate that elevated mitochondrial ROS within the CSF is a new index for the early detection of LSS. Moreover, it may represent a potential novel treatment target for LSS.
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Iatridis JC, Kang J, Kandel R, Risbud MV. New horizons in spine research: Intervertebral disc repair and regeneration. J Orthop Res 2017; 35:5-7. [PMID: 28114734 PMCID: PMC5482231 DOI: 10.1002/jor.23499] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- James C. Iatridis
- Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York 10029
| | - James Kang
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts 02115
| | - Rita Kandel
- Department of Pathology and Laboratory Medicine, Sinai Health System, Toronto, Ontario M5G1X5, Canada
| | - Makarand V. Risbud
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania 19107
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