147 Contrast Enhanced Ultrasound for The Evaluation of Intraoperative Spinal Cord Perfusion Before and After Surgical Decompression of a Chronically Compressed Spinal Cord

INTRODUCTION: There is conflicting literature regarding the pathophysiology of spontaneous neurologic deficits following posterior cervicothoracic decompression for chronic spinal cord compression and myeloradiculopathy. While spinal cord perfusion changes occurring intraoperatively is a prevailing theory, there is a paucity in imaging modalities to assess and quantify spinal cord perfusion. Contrast enhanced ultrasound (CEUS) shows great promise for evaluating perfusion of neural structures. We hypothesized that before and after decompression of a chronically compressed cervico-thoracic spinal cord, subjects will have detectable levels of spinal cord perfusion changes quantifiable by CEUS, and these changes will correlate with development of postoperative neurologic deficits and rate of recovery. METHODS: 20 adult subjects undergoing elective posterior cervicothoracic decompression surgery were enrolled in this clinical trial (NCT05530798). Prior to and directly after surgical decompression of the spinal cord, a 10 µL/kg bolus of DEFINITY® contrast agent was injected intravenously followed by visualization of the spinal cord in the midline, sagittal plane for a total of 120 seconds. Neuromonitoring and continuous blood pressure was monitored throughout the case. Time intensity curve analyses (TIC) and parametric color maps were used to analyze the CEUS data. RESULTS: Our interim analysis confirms that CEUS can be used intraoperatively to detect regional perfusion of the spinal cord pre- and post-decompression. Moreover, prolonged time-to-peak and washout perfusion periods correlate with the development of post-operative deficits as well as intraoperative neuromonitoring changes. CONCLUSIONS: CEUS can effectively quantify regional perfusion of the spinal cord pre- and post-decompression. Further follow up and perfusion quantification will continue to unveil data that can be further correlated with neurologic and functional outcomes.