Guangdong Provincial Biomedical Innovation Platform of Regeneration and Repair of Spinal Cord and Nerve Injury, Department of Orthopedic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, People's Republic of China.
Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology/Orthopaedic Research Institute, Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, 510080, People's Republic of China.
Eur Radiol. 2021 Nov;31(11):8478-8487. doi: 10.1007/s00330-021-08000-x. Epub 2021 Apr 30.
To compare the neurological recovery between patients with adequate and inadequate immediate spinal cord expansion after sufficient decompression in degenerative cervical myelopathy (DCM).
Twenty-seven patients subjected to French-door laminoplasty underwent the guidance of intraoperative ultrasound (IOUS) and were prospectively included. The modified Japanese Orthopedic Association (mJOA) score was evaluated before surgery and at 12 months postoperatively. The maximum spinal cord compression (MSCC) after sufficient decompression was calculated on the IOUS image; patients were divided into adequate (MSCC ≥ 0.95) and inadequate (MSCC < 0.95) expansion groups according to the MSCC. The mJOA score, spinal cord hyperechogenicity, age at surgery, symptom duration, occupational rate of the spinal canal, and the minimum anteroposterior diameter of the spinal cord between the two groups were compared.
Initially, 2 cases showed residual compression on IOUS; after further decompression, all patients acquired sufficient decompression. All patients achieved improvements in mJOA scores with an average recovery rate of 68.6 ± 20.3%. The recovery rate of the mJOA score of the inadequate expansion group was significantly inferior to that of the adequate expansion group (59.2 ± 21.7% versus 76.2 ± 16.2%, p = 0.028). The spinal cord hyperechogenicity was more common in the inadequate expansion group, while the spinal cord anteroposterior diameter of the inadequate expansion group was significantly smaller than that of the adequate expansion group.
The application of IOUS in French-door laminoplasty could help to confirm sufficient decompression for the treatment of DCM. Inadequate spinal cord expansion after sufficient decompression had the high possibility of predicting less satisfactory neurological recovery of DCM.
• The intraoperative ultrasound revealed that not all degenerative cervical myelopathy patients acquired adequate spinal cord expansion after sufficient decompression. • Patients who failed to acquire adequate spinal cord expansion commonly combined with spinal cord hyperechogenicity and trended to achieve less satisfactory neurological recovery after surgical decompression. • Inadequate spinal cord expansion after sufficient decompression had the high possibility of predicting less satisfactory neurological recovery of patients with degenerative cervical myelopathy.
比较充分减压后脊髓即刻扩张充分与不充分的退行性颈椎病（DCM）患者的神经恢复情况。
27 例行法式门型椎板成形术的患者接受术中超声（IOUS）引导，前瞻性纳入研究。手术前和术后 12 个月评估改良日本矫形协会（mJOA）评分。在 IOUS 图像上计算充分减压后脊髓最大受压（MSCC）；根据 MSCC 将患者分为充分扩张组（MSCC≥0.95）和不充分扩张组（MSCC＜0.95）。比较两组 mJOA 评分、脊髓高回声、手术年龄、症状持续时间、椎管职业率以及脊髓前后径最小直径。
最初 2 例 IOUS 显示残留压迫，进一步减压后，所有患者均获得充分减压。所有患者的 mJOA 评分均有改善，平均恢复率为 68.6%±20.3%。不充分扩张组的 mJOA 评分恢复率明显低于充分扩张组（59.2%±21.7%比 76.2%±16.2%，p=0.028）。不充分扩张组脊髓高回声更为常见，而不充分扩张组脊髓前后径明显小于充分扩张组。
在法式门型椎板成形术中应用 IOUS 有助于确认 DCM 的充分减压。充分减压后脊髓扩张不足极有可能预示 DCM 的神经恢复不理想。
•术中超声显示并非所有退行性颈椎病患者在充分减压后均获得充分的脊髓扩张。•未能获得充分脊髓扩张的患者常伴有脊髓高回声，并倾向于在减压手术后获得不理想的神经恢复。•充分减压后脊髓扩张不足极有可能预示退行性颈椎病患者的神经恢复不理想。
