Cargando…

Compressive Pressure Versus Time in Cauda Equina Syndrome: A Systematic Review and Meta-Analysis of Experimental Studies

Systematic review and meta-analysis. OBJECTIVE. To examine the relationship between compressive pressure and its duration in cauda equina compression, and the effects of subsequent decompression, on neurophysiological function, and pathophysiology in animal studies. We further aim to investigate the...

Descripción completa

Detalles Bibliográficos
Autores principales: Pronin, Savva, Koh, Chan Hee, Bulovaite, Edita, Macleod, Malcolm R., Statham, Patrick F.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6855389/
https://www.ncbi.nlm.nih.gov/pubmed/30973513
http://dx.doi.org/10.1097/BRS.0000000000003045
_version_ 1783470385607475200
author Pronin, Savva
Koh, Chan Hee
Bulovaite, Edita
Macleod, Malcolm R.
Statham, Patrick F.
author_facet Pronin, Savva
Koh, Chan Hee
Bulovaite, Edita
Macleod, Malcolm R.
Statham, Patrick F.
author_sort Pronin, Savva
collection PubMed
description Systematic review and meta-analysis. OBJECTIVE. To examine the relationship between compressive pressure and its duration in cauda equina compression, and the effects of subsequent decompression, on neurophysiological function, and pathophysiology in animal studies. We further aim to investigate these relationships with systemic blood pressure to assess whether a vascular component in the underlying mechanism may contribute to the clinical heterogeneity of this disease. SUMMARY OF BACKGROUND DATA. The complex relationship between preoperative factors and outcomes in cauda equina syndrome (CES) suggests heterogeneity within CES which may inform better understanding of pathophysiological process, their effect on neurological function, and prognosis. METHODS. Systematic review identified 17 relevant studies including 422 animals and reporting electrophysiological measures (EP), histopathology, and blood flow. Modeling using meta-regression analyzed the relationship between compressive pressure, duration of compression, and electrophysiological function in both compression and decompression studies. RESULTS. Modeling suggested that electrophysiological dysfunction in acute cauda equina compression has a sigmoidal response, with particularly deterioration when mean arterial blood pressure is exceeded and, additionally, sustained for approximately 1 hour. Accounting for pressure and duration may help risk-stratify patients pre-decompression. Outcomes after decompression appeared to be related more to the degree of compression, where exceeding systolic blood pressure tended to result in an irreversible lesion, rather than duration of compression. Prognosis was most strongly associated with residual pre-decompression function. CONCLUSION. Compressive pressure influences effects and outcomes of cauda equina compression. We suggest the presence of two broad phenotypic groups within CES defined by the degree of ischaemia as a potential explanatory pathophysiological mechanism. Level of Evidence: 1
format Online
Article
Text
id pubmed-6855389
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher Lippincott Williams & Wilkins
record_format MEDLINE/PubMed
spelling pubmed-68553892020-02-03 Compressive Pressure Versus Time in Cauda Equina Syndrome: A Systematic Review and Meta-Analysis of Experimental Studies Pronin, Savva Koh, Chan Hee Bulovaite, Edita Macleod, Malcolm R. Statham, Patrick F. Spine (Phila Pa 1976) Literature Review Systematic review and meta-analysis. OBJECTIVE. To examine the relationship between compressive pressure and its duration in cauda equina compression, and the effects of subsequent decompression, on neurophysiological function, and pathophysiology in animal studies. We further aim to investigate these relationships with systemic blood pressure to assess whether a vascular component in the underlying mechanism may contribute to the clinical heterogeneity of this disease. SUMMARY OF BACKGROUND DATA. The complex relationship between preoperative factors and outcomes in cauda equina syndrome (CES) suggests heterogeneity within CES which may inform better understanding of pathophysiological process, their effect on neurological function, and prognosis. METHODS. Systematic review identified 17 relevant studies including 422 animals and reporting electrophysiological measures (EP), histopathology, and blood flow. Modeling using meta-regression analyzed the relationship between compressive pressure, duration of compression, and electrophysiological function in both compression and decompression studies. RESULTS. Modeling suggested that electrophysiological dysfunction in acute cauda equina compression has a sigmoidal response, with particularly deterioration when mean arterial blood pressure is exceeded and, additionally, sustained for approximately 1 hour. Accounting for pressure and duration may help risk-stratify patients pre-decompression. Outcomes after decompression appeared to be related more to the degree of compression, where exceeding systolic blood pressure tended to result in an irreversible lesion, rather than duration of compression. Prognosis was most strongly associated with residual pre-decompression function. CONCLUSION. Compressive pressure influences effects and outcomes of cauda equina compression. We suggest the presence of two broad phenotypic groups within CES defined by the degree of ischaemia as a potential explanatory pathophysiological mechanism. Level of Evidence: 1 Lippincott Williams & Wilkins 2019-08-01 2019-04-08 /pmc/articles/PMC6855389/ /pubmed/30973513 http://dx.doi.org/10.1097/BRS.0000000000003045 Text en Copyright © 2019 The Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by-nc-nd/4.0 This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0
spellingShingle Literature Review
Pronin, Savva
Koh, Chan Hee
Bulovaite, Edita
Macleod, Malcolm R.
Statham, Patrick F.
Compressive Pressure Versus Time in Cauda Equina Syndrome: A Systematic Review and Meta-Analysis of Experimental Studies
title Compressive Pressure Versus Time in Cauda Equina Syndrome: A Systematic Review and Meta-Analysis of Experimental Studies
title_full Compressive Pressure Versus Time in Cauda Equina Syndrome: A Systematic Review and Meta-Analysis of Experimental Studies
title_fullStr Compressive Pressure Versus Time in Cauda Equina Syndrome: A Systematic Review and Meta-Analysis of Experimental Studies
title_full_unstemmed Compressive Pressure Versus Time in Cauda Equina Syndrome: A Systematic Review and Meta-Analysis of Experimental Studies
title_short Compressive Pressure Versus Time in Cauda Equina Syndrome: A Systematic Review and Meta-Analysis of Experimental Studies
title_sort compressive pressure versus time in cauda equina syndrome: a systematic review and meta-analysis of experimental studies
topic Literature Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6855389/
https://www.ncbi.nlm.nih.gov/pubmed/30973513
http://dx.doi.org/10.1097/BRS.0000000000003045
work_keys_str_mv AT proninsavva compressivepressureversustimeincaudaequinasyndromeasystematicreviewandmetaanalysisofexperimentalstudies
AT kohchanhee compressivepressureversustimeincaudaequinasyndromeasystematicreviewandmetaanalysisofexperimentalstudies
AT bulovaiteedita compressivepressureversustimeincaudaequinasyndromeasystematicreviewandmetaanalysisofexperimentalstudies
AT macleodmalcolmr compressivepressureversustimeincaudaequinasyndromeasystematicreviewandmetaanalysisofexperimentalstudies
AT stathampatrickf compressivepressureversustimeincaudaequinasyndromeasystematicreviewandmetaanalysisofexperimentalstudies