Intraoperative ultrasonography in laminectomy for degenerative cervical spondylotic myelopathy: a clinical and radiological evaluation.
Cervical myelopathy
Intraoperative sonography
Journal
Acta neurochirurgica
ISSN: 0942-0940
Titre abrégé: Acta Neurochir (Wien)
Pays: Austria
ID NLM: 0151000
Informations de publication
Date de publication:
07 2022
07 2022
Historique:
received:
27
01
2022
accepted:
22
04
2022
pubmed:
11
5
2022
medline:
29
6
2022
entrez:
10
5
2022
Statut:
ppublish
Résumé
The incidence of cervical myelopathy due to spinal stenosis is constantly growing in an aging population. Especially in multisegmental disease, dorsal laminectomy is the intervention of choice. Intraoperative imaging with ultrasound might provide additional information about extent and sufficiency of spinal cord decompression. In this prospective study, the width of the subarachnoid space was systematically measured by intraoperative ultrasound at predefined sites at the cranial and caudal edge of decompression in axial and sagittal reconstruction. These data were compared with corresponding sites on postoperative T2-weighted MRI imaging. In addition, the functional outcome was assessed by modified Japanese Orthopaedic Association (mJOA) score. A historical patient cohort treated without ultrasound-guided laminectomy served as control group. Altogether, 29 patients were included. According to mJOA score at last follow-up, 7/29 patients reported stable symptoms and 21/29 patients showed a substantial benefit with no or minor residual neurological deficits. One patient suffered from a new C5 palsy. Intraoperative ultrasound-guided posterior decompression provided excellent overview in all cases. Measurement of the width of the subarachnoid space acquired by intraoperative ultrasound and postoperative MRI images showed a very high correlation, especially at the cranial level (p < 0.001, r = 0.880). Bland-Altman analysis showed that most patients were within the 1.96 × SD limits of agreement throughout all measurements. No ultrasound procedure-related complications were observed. Compared to a historical cohort of 27 patients, no significant differences were found regarding functional outcome (p = 0.711). Intraoperative sonography visualises the surgically achieved restoration of the subarachnoid space in good correlation with postoperative MRI and might serve as a fast, precise and reliable tool for intraoperative imaging in cervical laminectomy. However, we could not demonstrate a clinical benefit with regard to functional outcome.
Sections du résumé
BACKGROUND
The incidence of cervical myelopathy due to spinal stenosis is constantly growing in an aging population. Especially in multisegmental disease, dorsal laminectomy is the intervention of choice. Intraoperative imaging with ultrasound might provide additional information about extent and sufficiency of spinal cord decompression.
METHODS
In this prospective study, the width of the subarachnoid space was systematically measured by intraoperative ultrasound at predefined sites at the cranial and caudal edge of decompression in axial and sagittal reconstruction. These data were compared with corresponding sites on postoperative T2-weighted MRI imaging. In addition, the functional outcome was assessed by modified Japanese Orthopaedic Association (mJOA) score. A historical patient cohort treated without ultrasound-guided laminectomy served as control group.
RESULTS
Altogether, 29 patients were included. According to mJOA score at last follow-up, 7/29 patients reported stable symptoms and 21/29 patients showed a substantial benefit with no or minor residual neurological deficits. One patient suffered from a new C5 palsy. Intraoperative ultrasound-guided posterior decompression provided excellent overview in all cases. Measurement of the width of the subarachnoid space acquired by intraoperative ultrasound and postoperative MRI images showed a very high correlation, especially at the cranial level (p < 0.001, r = 0.880). Bland-Altman analysis showed that most patients were within the 1.96 × SD limits of agreement throughout all measurements. No ultrasound procedure-related complications were observed. Compared to a historical cohort of 27 patients, no significant differences were found regarding functional outcome (p = 0.711).
CONCLUSION
Intraoperative sonography visualises the surgically achieved restoration of the subarachnoid space in good correlation with postoperative MRI and might serve as a fast, precise and reliable tool for intraoperative imaging in cervical laminectomy. However, we could not demonstrate a clinical benefit with regard to functional outcome.
Identifiants
pubmed: 35536511
doi: 10.1007/s00701-022-05232-8
pii: 10.1007/s00701-022-05232-8
pmc: PMC9233640
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1873-1881Informations de copyright
© 2022. The Author(s).
Références
Akter F, Kotter M (2018) Pathobiology of degenerative cervical myelopathy. Neurosurg Clin N Am 29:13–19. https://doi.org/10.1016/j.nec.2017.09.015
doi: 10.1016/j.nec.2017.09.015
pubmed: 29173425
Baba H, Uchida K, Maezawa Y, Furusawa N, Azuchi M, Imura S (1996) Lordotic alignment and posterior migration of the spinal cord following en bloc open-door laminoplasty for cervical myelopathy: a magnetic resonance imaging study. J Neurol 243:626–632
doi: 10.1007/BF00878657
Badiee RK, Mayer R, Pennicooke B, Chou D, Mummaneni PV, Tan LA (2020) Complications following posterior cervical decompression and fusion: a review of incidence, risk factors, and prevention strategies. J Spine Surg 6:323–333. https://doi.org/10.21037/jss.2019.11.01
doi: 10.21037/jss.2019.11.01
pubmed: 32309669
pmcid: 7154364
Bajamal AH, Kim SH, Arifianto MR, Faris M, Subagio EA, Roitberg B, Udo-Inyang I, Belding J, Zileli M, Parthiban J et al (2019) Posterior surgical techniques for cervical spondylotic myelopathy WFNS Spine Committee Recommendations. Neurospine 16:421–434. https://doi.org/10.14245/ns.1938274.137
doi: 10.14245/ns.1938274.137
pubmed: 31607074
pmcid: 6790723
Chen G, Li J, Wei F, Ji Q, Sui W, Chen B, Zou X, Xu Z, Liu X, Liu S (2020) Short-term predictive potential of quantitative assessment of spinal cord impairment in patients undergoing French-door Laminoplasty for degenerative cervical myelopathy: preliminary results of an exploratory study exploiting intraoperative ultrasound data. BMC Musculoskelet Disord 21:336. https://doi.org/10.1186/s12891-020-03319-w
doi: 10.1186/s12891-020-03319-w
pubmed: 32473626
pmcid: 7261379
Chen G, Wu H, Chen N, Wang M, Shi L, Li J, Wei F, Xu Z, Liu X, Liu S (2022) Potential of intraoperative ultrasonographic assessment of the spinal cord central echo complex in predicting postoperative neurological recovery of degenerative cervical myelopathy. Eur J Neurol 29:217–224. https://doi.org/10.1111/ene.15109
doi: 10.1111/ene.15109
pubmed: 34528341
Geck MJ, Eismont FJ (2002) Surgical options for the treatment of cervical spondylotic myelopathy. Orthop Clin North Am 33:329–348
doi: 10.1016/S0030-5898(02)00002-0
Han B, Wu D, Jia W, Lin S, Xu Y (2020) Intraoperative ultrasound and contrast-enhanced ultrasound in surgical treatment of intramedullary spinal tumors. World Neurosurg 137:e570–e576. https://doi.org/10.1016/j.wneu.2020.02.059
doi: 10.1016/j.wneu.2020.02.059
pubmed: 32081827
Hatta Y, Shiraishi T, Hase H, Yato Y, Ueda S, Mikami Y, Harada T, Ikeda T, Kubo T (2005) Is posterior spinal cord shifting by extensive posterior decompression clinically significant for multisegmental cervical spondylotic myelopathy? Spine 30:2414–2419
doi: 10.1097/01.brs.0000184751.80857.3e
Kato S, Ganau M, Fehlings MG (2018) Surgical decision-making in degenerative cervical myelopathy - anterior versus posterior approach. J Clin Neurosci 58:7–12. https://doi.org/10.1016/j.jocn.2018.08.046
doi: 10.1016/j.jocn.2018.08.046
pubmed: 30279123
Kawakami N, Mimatsu K, Kato F, Sato K, Matsuyama Y (1994) Intraoperative ultrasonographic evaluation of the spinal cord in cervical myelopathy. Spine (Phila Pa 1976) 19:34–41
doi: 10.1097/00007632-199401000-00007
Kimura A, Seichi A, Inoue H, Endo T, Sato M, Higashi T, Hoshino Y (2012) Ultrasonographic quantification of spinal cord and dural pulsations during cervical laminoplasty in patients with compressive myelopathy. Eur Spine J 21:2450–2455. https://doi.org/10.1007/s00586-012-2430-9
doi: 10.1007/s00586-012-2430-9
pubmed: 22820915
pmcid: 3508211
Kratzig T, Mohme M, Mende KC, Eicker SO, Floeth FW (2017) Impact of the surgical strategy on the incidence of C5 nerve root palsy in decompressive cervical surgery. PLoS ONE 12:e0188338. https://doi.org/10.1371/journal.pone.0188338
doi: 10.1371/journal.pone.0188338
pubmed: 29145512
pmcid: 5690695
Kumar VG, Rea GL, Mervis LJ, McGregor JM (1999) Cervical spondylotic myelopathy: functional and radiographic long-term outcome after laminectomy and posterior fusion. Neurosurgery 44:771–777 (discussion 777–778)
doi: 10.1097/00006123-199904000-00046
Lawrence BD, Brodke DS (2012) Posterior surgery for cervical myelopathy: indications, techniques, and outcomes. The Orthopedic clinics of North America 43:29–40. https://doi.org/10.1016/j.ocl.2011.09.003 (vii-viii)
doi: 10.1016/j.ocl.2011.09.003
pubmed: 22082627
Lawrence BD, Jacobs WB, Norvell DC, Hermsmeyer JT, Chapman JR, Brodke DS (2013) Anterior versus posterior approach for treatment of cervical spondylotic myelopathy: a systematic review. Spine 38:S173-182. https://doi.org/10.1097/BRS.0b013e3182a7eaaf
doi: 10.1097/BRS.0b013e3182a7eaaf
pubmed: 23962995
Lee JY, Sharan A, Baron EM, Lim MR, Grossman E, Albert TJ, Vaccaro AR, Hilibrand AS (2006) Quantitative prediction of spinal cord drift after cervical laminectomy and arthrodesis. Spine 31:1795–1798. https://doi.org/10.1097/01.brs.0000225992.26154.d0
doi: 10.1097/01.brs.0000225992.26154.d0
pubmed: 16845353
Machino M, Yukawa Y, Ito K, Inoue T, Kobayakawa A, Matsumoto T, Ouchida J, Tomita K, Kato F (2014) Risk factors for poor outcome of cervical laminoplasty for cervical spondylotic myelopathy in patients with diabetes. J Bone Joint Surg Am 96:2049–2055. https://doi.org/10.2106/JBJS.N.00064
doi: 10.2106/JBJS.N.00064
pubmed: 25520338
Matsuyama Y, Kawakami N, Mimatsu K (1995) Spinal cord expansion after decompression in cervical myelopathy. Investigation by computed tomography myelography and ultrasonography. Spine 20:1657–1663. https://doi.org/10.1097/00007632-199508000-00002
doi: 10.1097/00007632-199508000-00002
pubmed: 7482013
Mihara H, Kondo S, Takeguchi H, Kohno M, Hachiya M (2007) Spinal cord morphology and dynamics during cervical laminoplasty: evaluation with intraoperative sonography. Spine (Phila Pa 1976) 32:2306–2309. https://doi.org/10.1097/BRS.0b013e318155784d
doi: 10.1097/BRS.0b013e318155784d
Nishimura Y, Thani NB, Tochigi S, Ahn H, Ginsberg HJ (2014) Thoracic discectomy by posterior pedicle-sparing, transfacet approach with real-time intraoperative ultrasonography: Clinical article. J Neurosurg Spine 21:568–576. https://doi.org/10.3171/2014.6.SPINE13682
doi: 10.3171/2014.6.SPINE13682
pubmed: 25036220
Nishizawa K, Mori K, Saruhashi Y, Matsusue Y (2012) Operative outcomes for cervical degenerative disease: a review of the literature. ISRN Orthopedics 2012:165050. https://doi.org/10.5402/2012/165050
doi: 10.5402/2012/165050
pubmed: 24977072
pmcid: 4063127
Prada F, Vetrano IG, Filippini A, Del Bene M, Perin A, Casali C, Legnani F, Saini M, DiMeco F (2014) Intraoperative ultrasound in spinal tumor surgery. J Ultrasound 17:195–202. https://doi.org/10.1007/s40477-014-0102-9
doi: 10.1007/s40477-014-0102-9
pubmed: 25177392
pmcid: 4142127
Schar RT, Wilson JR, Ginsberg HJ (2019) Intraoperative ultrasound-guided posterior cervical laminectomy for degenerative cervical myelopathy. World Neurosurg 121:62–70. https://doi.org/10.1016/j.wneu.2018.09.217
doi: 10.1016/j.wneu.2018.09.217
pubmed: 30312813
Sodeyama T, Goto S, Mochizuki M, Takahashi J, Moriya H (1999) Effect of decompression enlargement laminoplasty for posterior shifting of the spinal cord. Spine 24:1527–1531 (discussion 1531–1522)
doi: 10.1097/00007632-199908010-00005
Tan LA, Lopes DK, Fontes RB (2014) Ultrasound-guided posterolateral approach for midline calcified thoracic disc herniation. J Korean Neurosurg Soc 55:383–386. https://doi.org/10.3340/jkns.2014.55.6.383
doi: 10.3340/jkns.2014.55.6.383
pubmed: 25237439
pmcid: 4166339
Tetreault L, Kopjar B, Nouri A, Arnold P, Barbagallo G, Bartels R, Qiang Z, Singh A, Zileli M, Vaccaro A et al (2017) The modified Japanese Orthopaedic Association scale: establishing criteria for mild, moderate and severe impairment in patients with degenerative cervical myelopathy. Eur Spine J 26:78–84. https://doi.org/10.1007/s00586-016-4660-8
doi: 10.1007/s00586-016-4660-8
pubmed: 27342612
Wessell A, Mushlin H, Fleming C, Lewis E, Sansur C (2018) Thoracic discectomy through a unilateral transpedicular or costotransversectomy approach With Intraoperative Ultrasound Guidance. Oper Neurosurg (Hagerstown): https://doi.org/10.1093/ons/opy348
Xia G, Tian R, Xu T, Li H, Zhang X (2011) Spinal posterior movement after posterior cervical decompression surgery: clinical findings and factors affecting postoperative functional recovery. Orthopedics 34:e911-918. https://doi.org/10.3928/01477447-20111021-03
doi: 10.3928/01477447-20111021-03
pubmed: 22146210
Young WF (2000) Cervical spondylotic myelopathy: a common cause of spinal cord dysfunction in older persons. Am Fam Physician 62(1064–1070):1073
Zhang JT, Wang LF, Wang S, Li J, Shen Y (2016) Risk factors for poor outcome of surgery for cervical spondylotic myelopathy. Spinal Cord 54:1127–1131. https://doi.org/10.1038/sc.2016.64
doi: 10.1038/sc.2016.64
pubmed: 27137121