Ultrasound in Traumatic Spinal Cord Injury: A Wide-Open Field

Neurosurgery, 2021 · DOI: https://doi.org/10.1093/neuros/nyab177 · Published: September 1, 2021

Spinal Cord Injury Neurology Medical Imaging

Simple Explanation

Traumatic spinal cord injury (SCI) is a common and devastating condition with limited effective treatments. Novel approaches are needed for injury stabilization, regeneration, and functional restoration. Ultrasound is a versatile technology with potential for diagnostic and therapeutic interventions in SCI, including real-time monitoring, targeted drug delivery, and neuromodulation. Current research on ultrasound in SCI is lacking, but continued technological advancements may help overcome challenges and bring ultrasound to the forefront of SCI research and development.

Study Duration

Not specified

Participants

Review article

Evidence Level

Level 5, Review

Key Findings

1
Ultrasound can enable real-time In Vivo spinal cord monitoring with high spatiotemporal resolution, overcoming limitations of existing modalities.
2
Ultrasound molecular imaging (UMI) can be used to perform real-time In Vivo biomarker detection and quantification following SCI.
3
LIFU's diverse effects on the central nervous system (CNS) including vascular permeability modulation, neuromodulation, neuroprotection, and local therapeutics delivery are directly applicable to SCI.

Research Summary

This review explores the potential of ultrasound technology for diagnostic and therapeutic interventions in traumatic spinal cord injury (SCI). The authors discuss the fundamentals of ultrasound, including diagnostic ultrasound and focused ultrasound (FUS), and review relevant preclinical and clinical studies. The review concludes that ultrasound holds promise for SCI management through perfusion monitoring, biomarker imaging, and focused ultrasound techniques, but further research is needed to address technical challenges and define its utility.

Practical Implications

Real-time SCI Monitoring

Ultrasound can provide novel actionable biomarkers in real time to help clinicians make treatment decisions, fine-tune interventions, and prognosticate to improve outcome after traumatic SCI.

Targeted Drug Delivery

LIFU-based focal drug delivery holds significant promise in facilitating the development and testing of novel therapies in the spinal cord.

Adaptive Neuromodulation

Ultrasound systems can be readily configured to deliver adaptive, multifocal, and dual-mode therapies for SCI, potentially improving axonal growth and neuroprotection.

Study Limitations

1
Studies that evaluate the benefits and risks of ultrasound in SCI are severely lacking.
2
Complex anatomy and physiology of the spine and spinal cord.
3
Technical challenges of working with the spinal cord due to its deep location and enclosure within the vertebrae.

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