Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Department of Epidemiology and Public Health, Division of Biostatistics and Bioinformatics, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Neurosurgery. 2023 Feb 1;92(2):353-362. doi: 10.1227/neu.0000000000002207. Epub 2022 Nov 23.
Decompression of the injured spinal cord confers neuroprotection. Compared with timing of surgery, verification of surgical decompression is understudied.
To compare the judgment of cervical spinal cord decompression using real-time intraoperative ultrasound (IOUS) following laminectomy with postoperative MRI and CT myelography.
Fifty-one patients were retrospectively reviewed. Completeness of decompression was evaluated by real-time IOUS and compared with postoperative MRI (47 cases) and CT myelography (4 cases).
Five cases (9.8%) underwent additional laminectomy after initial IOUS evaluation to yield a final judgment of adequate decompression using IOUS in all 51 cases (100%). Postoperative MRI/CT myelography showed adequate decompression in 43 cases (84.31%). Six cases had insufficient bony decompression, of which 3 (50%) had cerebrospinal fluid effacement at >1 level. Two cases had severe circumferential intradural swelling despite adequate bony decompression. Between groups with and without adequate decompression on postoperative MRI/CT myelography, there were significant differences for American Spinal Injury Association motor score, American Spinal Injury Association Impairment Scale grade, AO Spine injury morphology, and intramedullary lesion length (IMLL). Multivariate analysis using stepwise variable selection and logistic regression showed that preoperative IMLL was the most significant predictor of inadequate decompression on postoperative imaging (P = .024).
Patients with severe clinical injury and large IMLL were more likely to have inadequate decompression on postoperative MRI/CT myelography. IOUS can serve as a supplement to postoperative MRI/CT myelography for the assessment of spinal cord decompression. However, further investigation, additional surgeon experience, and anticipation of prolonged swelling after surgery are required.
减压可对受伤的脊髓提供神经保护。与手术时机相比，减压手术的验证研究较少。
比较椎板切除术后实时术中超声（IOUS）与术后 MRI 和 CT 脊髓造影对颈椎脊髓减压的判断。
回顾性分析 51 例患者。采用实时 IOUS 评估减压的完整性，并与术后 MRI（47 例）和 CT 脊髓造影（4 例）进行比较。
5 例（9.8%）在初始 IOUS 评估后行额外椎板切除术，51 例（100%）最终通过 IOUS 获得充分减压的判断。术后 MRI/CT 脊髓造影显示 43 例（84.31%）减压充分。6 例存在骨减压不足，其中 3 例（50%）有 1 个以上水平的脑脊液消失。2 例尽管骨减压充分，但仍存在严重的环形硬脊膜下肿胀。在术后 MRI/CT 脊髓造影减压充分与不充分的组间，美国脊柱损伤协会运动评分、美国脊柱损伤协会损伤分级、AO 脊柱损伤形态和脊髓内病变长度（IMLL）有显著差异。使用逐步变量选择和逻辑回归的多变量分析显示，术前 IMLL 是术后影像学评估减压不充分的最显著预测因子（P =.024）。
术前 IMLL 较大且临床损伤严重的患者术后 MRI/CT 脊髓造影减压不充分的可能性更高。IOUS 可作为术后 MRI/CT 脊髓造影评估脊髓减压的补充手段。但需要进一步研究、增加术者经验，并预期术后肿胀时间延长。
