Contrast-Enhanced Ultrasound Biomarker for Prognostication and Guidance of Surgical Treatment in Acute Traumatic Spinal Cord Injury
Abstract
Objective: Our objective is to establish an acute, measurable biomarker to guide therapeutic interventions and to predict neurological recovery of patients with acute traumatic spinal cord injury (tSCI). Rationale: When you happen to badly pinch your finger in a door, the typical response is to quickly remove the compressive forces and seek medical attention. The treatment of tSCI follows the same principle as we attempt to surgically decompress the traumatized spinal cord within 24 hours after the injury. The violent mechanical forces resulting in tSCI can cause different types of impinging pathology, some of which might not be recognized and addressed using current surgical techniques as we lack intraoperative biomarkers monitoring adequate spinal cord decompression. Accordingly, in a third of the patients, adequate surgical spinal cord decompression is not achieved. Here, we propose a real-time intraoperative imaging biomarker for acute tSCI that provides the following information: (1) evaluation of adequate surgical spinal cord decompression, (2) a damage report of the injured spinal cord area, and (3) the probability of viability of tissue adjacent to the injury center. With the generous support of the US Department of Defense, we have developed ultrasound imaging techniques that assess blood flow in the traumatized rodent spinal cord tissue. Our research has shown that disturbance of blood flow at the injury site prognosticates the specific functional recovery of an individual animal. We are now able to use data acquired acutely after a trauma (< 24 hours) to predict how well spinal cord injured animals will recover the ability to walk months after injury. The tremendous potential of this biomarker is further corroborated by its ability to detect restoration of spinal cord tissue perfusion adjacent to the injury center in response to neuroprotective interventions. To facilitate clinical translation, we have shown that collection of such a biomarker is safe and feasible in patients with acute tSCI. Our main objective of the current proposal is to develop a standardized intraoperative biomarker that monitors completeness of spinal cord decompression and prognosticates the recovery of the individual patient. We envision that adoption of our biomarker will assist to elucidate risks and benefits of therapeutic interventions and serve as a foundation for personalized tSCI patient care. Ultimate Applicability of Our Research – Applications, Benefits, and Risks: Our research has the potential to help individuals who suffer from acute tSCI. The proposed ultrasound measurements to assess adequate spinal cord decompression will motivate additional surgical maneuvers in some patients and confirm accomplishment of this principal surgical goal in all patients enrolled with improved consistency. Once the prognostic capacity of our biomarker is established, it will allow the treating physician to inform the patient and their families regarding the expected neurological outcome. This will help with crucial care management decisions and to set realistic expectations for tSCI patients and their families. Last, our technology can stratify injury types (dependent on the amount of damaged spinal cord) which will help to enroll patients in appropriate clinical trials. Given the low cost and small footprint, our technology is also well suited for far-forward military operations, which could eventually reduce time for diagnosis and initiation of therapies. Moreover, since most Soldiers have traumatic injuries to multiple organ systems (brain, extremities, abdomen), our imaging technology’s impact could expand far beyond the current proposal, for example in diagnosis and treatment of traumatic extremity compartment syndromes. In summary, we envision that the proposed biomarker will have a tremendous impact for individuals with tSCI, as it allows for monitoring the completeness of spinal cord decompression and for p
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Jan 04, 2024
- Source ID
- HT94252310915
Entities
People
- Christoph Hofstetter
Organizations
- United States Army
- University of Washington