| Background:Cervical spondylotic myelopathy is the most serious condition of cervical spondylosis and a leading cause of spinal cord dysfunction in the adult population. Treatment options include operative and non-operative treatments. Surgical decompression is considered the gold standard of treatment. The objective of operative treatment is to adequately decompress the spinal cord and to maintain the stability of the spinal column. Appropriate operative treatment of cervical spondylotic myelopathy will result in satisfactory recovery from myelopathy in most cases. However, elective cervical decompression surgery is associated with spinal cord ischemia-reperfusion injury. Spinal cord ischemia-reperfusion injury after surgical decompression often leads to neurological deficits which seriously influence the quality of life after surgery and even threaten the survival of patients with cervical spondylotic myelopathy. Remote ischemic preconditioning (RIPC) reduces injury caused by ischemia-reperfusion in distant organs. RIPC has been proved to be protective against ischemia-reperfusion injury in brain, heart, liver, kidney, spinal cord, gut, and etc in many animal studies. Quite a few clinical trials have recently reported that remote ischemic preconditioning reduces myocardial and cerebral injury after major cardiovascular and neurovascular surgery. Remote ischemic preconditioning is a safe, effective, noninvasive, and cost-effective strategy for reducing ischemia-reperfusion injury in clinical settings. This study was designed to investigate whether limb remote ischemic preconditioning is beneficial to surgical outcome in patients with cervical spondylotic myelopathy, and to provide scientific basis for its clinical application in the future.ObjectiveTo investigate the effect of remote ischemic preconditioning on spinal cord ischemia-reperfusion injury in patients with cervical spondylotic myelopathy undergoing cervical decompression surgery. MethodsForty adult myelopathic patients undergoing elective cervical decompression surgery were randomly assigned to either a remote ischemic preconditioning group (n=20) or a control group (n=20) before induction of anesthesia. Limb remote ischemic preconditioning consisted of three 5-min cycles of right upper limb ischemia, induced by an automated cuff-inflator placed on the upper arm and inflated to 200 mmHg, with an intervening 5 min of reperfusion during which the cuff was deflated. Serum samples for measurements of S-100B and neuron-specific enolase (NSE) concentrations were drawn before the induction of anesthesia, before decompression, after decompression and at 6h, 1, 3, 5, 7days after surgery. Median nerve somatosensory evoked potentials (SEPs) were measured before, during and after surgery. Preoperative and postoperative neurological functional status was evaluated using a Japanese Orthopaedic Association (JOA) scale, and the recovery rate (RR) was calculated. Assessment was done before the operation, at 7 days and 1 month, 3 months, 6 months after surgery.Results1.Biochemical markers: Remote ischemic preconditioning significantly reduced serum S-100B release at 6 h, 1day after surgery and NSE release at 6h, 1, 3, 5days after surgery (P<0.05).2.Somatosensory evoked potentials: No differences in SEPs measurements at either time point and in the incidences of significant SEPs changes between Control group and RIPC group during the surgery were observed (P>0.05).3.The recovery rate: There were significant differences in the RR at 7 days and 1 month, 3 months after surgery between the two groups (P<0.05). ConclusionsThe present study demonstrates that adult myelopathic patients undergoing elective cervical decompression surgery at a single center could benefit from remote ischemic preconditioning, using transient upper limb ischemia. These novel data support the need for a larger multi-center clinical study of RIPC in patients undergoing elective cervical decompression surgery for cervical spondylotic myelopathy (CSM). |
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