Abstracts From the 52nd Annual Meeting of the Society for Neuroscience in Anesthesiology and Critical Care, September 12-14, 2024

Risk Factors for Chronic Dysphagia after Anterior Surgical Decompression for Degenerative Cervical Myelopathy: Results of the Multicenter, Randomized, Controlled, Phase III, CSM-Protect Clinical Trial Alex B. Bak, Ali Moghaddamjou, Michael G. Fehlings University of Toronto, Toronto, Canada Introduction: Early dysphagia is a common complication after anterior cervical surgery for degenerative cervical myelopathy (DCM). However, factors associated with the development of chronic postoperative dysphagia remain unclear. Chronic dysphagia can have devastating effects on patient quality-of-life, satisfaction, and contribute to malnutrition. The goal of this study was to evaluate the natural history of dysphagia after anterior surgery for DCM and to identify factors associated with chronic postoperative dysphagia. Methods: This ambispecitve cohort study included adult patients who received anterior decompressive surgery for DCM between 2012 to 2017 across 16 university-affiliated sites as part of the prospective, randomized CSM-Protect clinical trial. Presence and severity of dysphagia was assessed with the Bazaz scale, which grades patients’ dysphagia as none, mild, moderate, or severe based on frequency and type of food or liquid ingested. Latent class trajectory modelling (LCTM) was applied to classify patients into distinct trajectories based on their logitudnial Bazaz scale scores over the initial 1yr after surgery with time points at baseline, 1mo, 6mo, and 1yr. Predictors of recovery trajectories were identified using descriptive statistics and multivariate logistic regression with odds ratios (ORs) and 95% confidence intervals (CIs) on demographic and surgical variables. Results: From a total of 290 patients, 132 subjects met the eligibility criteria. Preoperatively, 11.4% of patients had moderate dysphagia, which peaked to 19.7% at 1mo with 7.6% developing severe dysphagia. This rate decreased to 11.4% of moderate and 3.8% of severe dysphagia at 6mo and further to 10.6% and 3.0%, respectively at 1yr. From this raw data, two distinct cubic trajectories for postoperative dysphagia were identified. Their polynomial course was classified as: 1) resolved early dysphagia (n=112, 84.9%), described by an early development of mild dysphagia by 1 month and rapid, complete resolution of symptoms by 6mo; and 2) chronic dysphagia (n=20, 15.1%), described by a development of mild to moderate dysphagia by 1mo and continued or worsening symptoms at 1yr. Demographically, older patients and male sex were associated with the resolved early dysphagia trajectory. Conversely, pertaining to comorbidities, patients with a history of psychiatric disorders such anxiety and depression was associated with chronic dysphagia trajectory. Additionally, presenting with gait impairment and having a stenotic cause due to hypertrophied ligamentum flavum was associated with unresolved dysphagia at 1yr. Conclusions: More than one in eight DCM patients that underwent anterior cervical surgery reported unresolved dysphagia of moderate or greater severity at one year. Younger patients and those with pre-existing anxiety and depression were more likely to report subjective long-term symptoms of dysphagia. Our findings lend support to the existence of a heterogenous group of patients wherein the customarily reported pattern of resolved early postoperative dysphagia may not apply. Relationship Between Pain and Functional and Health-related Outcome Measures in Degenerative Cervical Myelopathy: Results of a Prospective, Multicenter Dataset of 914 Patients Alex B. Bak, Ali Moghaddamjou, Michael G. Fehlings University of Toronto, Toronto, Canada Introduction: While pain is increasingly regarded as a top recovery priority by patients living with degenerative cervical myelopathy (DCM), this outcome has been under-recognized and understudied. Pain can be a driver to seek surgical intervention particularly in individuals with mild DCM. To address this gap, we examined the relationship between pain and other functional and health-related outcome measures in DCM. Methods: We identified patients who underwent surgical decompression for DCM from the prospective, multicenter AOSpine CSM-NA, CSM-I, and CSM-Protect trials. Outcomes were modified Japanese Orthopedic Association (mJOA) score, Nurick classification, Short Form 36 (SF36) Physical Component Summary (SF36-PCS), and SF36 Mental Component Summary. Pain was prospectively assessed using Neck Disability Index Pain Intensity (NDI-PI) score preoperatively, and at 6mo and 1yr follow up. Pain intensity was categorized as minimal (NDI-PI=0 or 1), moderate (NDI-PI=2), and severe (NDI-PI>2). Correlation between pain intensity as a continuous variable and outcome measures at each timepoint, as well as their changes at 1yr from baseline was described with Spearman’s ρ and P values. Correlation between change in pain and rate of minimum clinically important difference (MCID) for mJOA, SF36-PCS, and SF36-MCS was described with Pearson’s correlation coefficient r and P values. Results: Of 914 eligible DCM patients, 32.2% had severe preoperative pain, 29.1% moderate pain, and 38.7% had minimal pain. Pain intensity was poorly correlated with mJOA and Nurick preoperatively and all follow-up time points. SF36-PCS and SF36-MCS was significantly and moderately correlated with pain at all time points. Changes in mJOA was poorly correlated with changes in pain (ρ=−0.12; P<0.001) as was Nurick grade (ρ=0.15; P<0.001). Changes in patient-reported outcomes of SF36-PCS was significantly and fairly correlated with changes in pain (ρ=−0.37; P<0.001) as was SF36-MCS (ρ=−0.26; P<0.001). Changes in pain was poorly correlated with reaching MCID of mJOA (r=−0.10; P=0.152), but moderately correlated with reaching MCID for SF36-PCS (r=−0.29; P<0.001) and MCS (r=−0.22 P=0.001).In a subset of 156 mild DCM patients, 23.1% reported severe preoperative pain, 29.5% reported moderate pain, and 47.4% had minimal pain. The pain groups did not differ in demographic, medical, or procedural variables. Patients with greater pain was associated with lower self-reported preoperative mental health and physical functioning, but not preoperative Nurick or mJOA scores. Correlation trends were similar to the total DCM cohort. Conclusion: There is a high prevalence of preoperative pain in DCM patients who undergo surgery. The clinician-administered mJOA and Nurick classification are poorly correlated with pain and insensitive to changes in pain, postoperatively. Patient-reported outcomes of the Mental and Physical Component Summaries of the SF36 were moderately and significantly correlated with pain and changes in pain, postoperatively. Plasma GFAP and GAD65-Ab: new biomarkers for attention deficit hyperactivity disorder pathology Li-Min Zhang1, Hui-Tao Miao1, Yu-Dong Shan1, Ting-Ting Liu1, Dong-Xue Zhang2, Wei-Juan Gao3 1Hebei Province Cangzhou Hospital of Integrated Traditional and Western Medicine, Cangzhou, China. 2Cangzhou Central Hospital, Cangzhou, China. 3Hebei University of Chinese Medicine, Shijiazhuang, China Background Attention deficit hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder in children of school age. In mice with ADHD, glial fibrillary acidic protein (GFAP) levels were significantly higher, whereas glutamic acid decarboxylase 65 (GAD65) levels were lower. The goal of this study is to look at the potential function of GFAP and GAD65 antibodies (GAD65-Ab) in mice and children with ADHD by assessing GFAP and GAD65-Ab levels in the blood. Methods An ADHD model was established in pregnant mice with 15 mg/kg of S-ketamine administration using intraperitoneal injection for 5 days from G14 to G18. Children were enrolled if they met in ADHD Rating Scale (ARS) in DSM-5 criteria for ADHD based on clinical interviews. Venous blood was obtained from children and mice under aseptic conditions and the serum was centrifuged and preserved. Clear supernatants from mice and children were processed simultaneously in duplicate, side by side, for ELISA assay with the calibrators supplied in the GFAP and GAD65-Ab kit. Results In mice with ADHD-like behaviors, there was a strong positive connection between serum GFAP levels and open-arm times in the elevated plus maze, which corresponded with the association between serum GFAP levels and hyperactivity-impulsivity ratings The of serum GFAP levels as an for of ADHD was to be based on the a of and a of the under the was Additionally, we that in mice ADHD-like behaviors, a in time was to an in blood GAD65-Ab an of there was a between scores and serum GAD65-Ab levels r The support the that elevated blood levels of GFAP and GAD65-Ab may be in the of ADHD in children and that levels may be correlated with the severity of ADHD in of of and blood of and surgical of with have been to lower This report of a patient with of and and the of with a underwent The was by of the and and an of and were of with a high of was and the was elevated to using The patient was to the for and the elevated a was as the and was continued to of was and was in the of two of other of to The but to to and the blood was with a of the which the of for The and were and respectively and the to 5 and the surgery. The patient and was to the was from the had lower physical other after of and has not been In to and is to lower and of are in and an to other of which may time to by the is This was part of a to after of and the of have been and for surgical time is of the measures to but are not to of the and the of other of are may be more in in mild in mice of Hui-Tao Miao1, Li-Min Zhang1, Dong-Xue 1Hebei Province Cangzhou Hospital of Integrated Traditional and Western Medicine, Cangzhou, China. Cangzhou, China. Hospital of China. Central Hospital, Cangzhou, China that depression is a common mental health In a we identified that changes in a model of and However, there is of the potential of in depression under This study to and potential in such between Methods: mild in We assessed and changes at and using severity scores and potential Results: Our findings that with and significantly to the of and Additionally, that in and in in the with findings the potential of the of in under greater effects in mice to Conclusion: a in mice to mild to the of the in with the of The of and on Outcomes in of Medicine, University of Western and of Clinical University of Western and Canada Introduction: is a and on patient surgical and the individuals the surgery. is as a in surgical has the of on patient the of understudied. We a cohort study to the of on in surgery. 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