Journal Article

Tethered spinal cord tension assessed via ultrasound elastography in computational and intraoperative human studies

Kempski Leadingham, Kelley M., Lehner, Kurt, Punnoose, Joshua, Williams, Autumn, Hersh, Andrew M., Thakor, Nitish V., Smith, Beth, Son, Jennifer K., Shekhar, Himanshu, Paul, Abhijit, Mercado-Shekhar, Karla P., Theodore, Nicholas, Routkevitch, Denis, Davidar, A. Daniel, Manbachi, Amir, Kumar, Avisha, Kerensky, Max J., Judy, Brendan F., Azadi, Javad R.

2024

Overview

Background Tension in the spinal cord is a trademark of tethered cord syndrome. Unfortunately, existing tests cannot quantify tension across the bulk of the cord, making the diagnostic evaluation of stretch ambiguous. A potential non-destructive metric for spinal cord tension is ultrasound-derived shear wave velocity (SWV). The velocity is sensitive to tissue elasticity and boundary conditions including strain. We use the term Ultrasound Tensography to describe the acoustic evaluation of tension with SWV. Methods Our solution Tethered cord Assessment with Ultrasound Tensography (TAUT) was utilized in three sub-studies: finite element simulations, a cadaveric benchtop validation, and a neurosurgical case series. The simulation computed SWV for given tensile forces. The cadaveric model with induced tension validated the SWV-tension relationship. Lastly, SWV was measured intraoperatively in patients diagnosed with tethered cords who underwent treatment (spinal column shortening). The surgery alleviates tension by decreasing the vertebral column length. Results Here we observe a strong linear relationship between tension and squared SWV across the preclinical sub-studies. Higher tension induces faster shear waves in the simulation ( R 2  = 0.984) and cadaveric ( R 2  = 0.951) models. The SWV decreases in all neurosurgical procedures ( p  < 0.001). Moreover, TAUT has a c-statistic of 0.962 (0.92-1.00), detecting all tethered cords. Conclusions This study presents a physical, clinical metric of spinal cord tension. Strong agreement among computational, cadaveric, and clinical studies demonstrates the utility of ultrasound-induced SWV for quantitative intraoperative feedback. This technology is positioned to enhance tethered cord diagnosis, treatment, and postoperative monitoring as it differentiates stretched from healthy cords. Plain language summary Tethered spinal cord syndrome occurs when surrounding tissue attaches to and causes stretching across the spinal cord. People with a tethered cord can experience weakness, pain, and loss of bladder control. Although increased tension in the spinal cord is known to cause these symptoms, evaluating the amount of stretching remains challenging. We investigated the ability of an ultrasound imaging approach to measure spinal cord tension. We studied our method in a computer simulation, a benchtop validation model, and in six people with tethered cords during surgery that they were undergoing to reduce tension. In each phase, the approach could detect differences between stretched spinal cords and spinal cords in a healthy state. Our method could potentially be used in the future to improve the care of people with a tethered cord. Kerensky et al. quantify tension across human spinal cords in computational simulations, a cadaveric benchtop model, and a neurosurgical case series. Their direct methodology successfully differentiates stretched spinal cords from healthy states in all sub-studies.

• Publisher: Nature Publishing Group UK,Springer Nature B.V,Nature Portfolio
• Subject: 59 / 631/1647/245/1859 / 692/308/3187 / 692/308/53/2421 / 692/699/375/1824 / 692/700/1421/1860 / 9/10 / Magnetic resonance imaging / Medicine / Medicine & Public Health / Postoperative period / Propagation / Simulation / Spinal cord / Surgical techniques / Ultrasonic imaging / Ultrasonic transducers