• Owen P Leary, Elias A Shaaya, Alexander A Chernysh, Michael Seidler, Rahul A Sastry, Elijah Persad-Paisley, Michelle Zhu, Ziya L Gokaslan, Adetokunbo A Oyelese, Michael D Beland, and Jared S Fridley.
• Department of Neurosurgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA. Electronic address: owen_leary@brown.edu.
• World Neurosurg. 2024 Sep 1; 189: e404e410e404-e410.

BackgroundUltrasound imaging is inexpensive, portable, and widely available. The development of a real-time transcutaneous spinal cord perfusion monitoring system would allow more precise targeting of mean arterial pressure goals following acute spinal cord injury (SCI). There has been no prior demonstration of successful real-time cord perfusion monitoring in humans.MethodsFour adult patients who had undergone posterior cervical decompression and instrumentation at a single center were enrolled into this prospective feasibility study. All participants had undergone cervical laminectomies spanning ≥2 contiguous levels ≥2 months prior to inclusion with no history of SCI. The first 2 underwent transcutaneous ultrasound without contrast and the second 2 underwent contrast-enhanced ultrasound (CEUS) with intravenously injected microbubble contrast.ResultsUsing noncontrast ultrasound with or without Doppler (n = 2), the dura, spinal cord, and vertebral bodies were apparent however ultrasonography was insufficient to discern intramedullary perfusion or clear white-gray matter differentiation. With application of microbubble contrast (n = 2), it was possible to quantify differential spinal cord perfusion within and between cross-sectional regions of the cord. Further, it was possible to quantify spinal cord hemodynamic perfusion using CEUS by measuring peak signal intensity and the time to peak signal intensity after microbubble contrast injection. Time-intensity curves were generated and area under the curves were calculated as a marker of tissue perfusion.ConclusionsCEUS is a viable platform for monitoring real-time cord perfusion in patients who have undergone prior cervical laminectomies. Further development has the potential to change clinical management acute SCI by tailoring treatments to measured tissue perfusion parameters.Copyright © 2024 Elsevier Inc. All rights reserved.

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