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, China.
Department of Orthopaedic Surgery, The First Affiliated Hospital, Jinan University, Guangzhou, China.
Eur Radiol. 2024 Feb;34(2):736-744. doi: 10.1007/s00330-023-10032-4. Epub 2023 Aug 15.
To investigate the feasibility and effectiveness of applying intraoperative ultrasound (IOUS) to evaluate spinal canal expansion in patients undergoing French-door cervical laminoplasty (FDCL).
Twenty-five patients who underwent FDCL for multilevel degenerative cervical myelopathy were prospectively recruited. Formulae describing the relationship between laminoplasty opening angle (LOA) and laminoplasty opening size, the increase in sagittal canal diameter and the spinal canal area were deduced with trigonometric functions. The LOA was measured with IOUS imaging during surgery, and other spinal canal parameters were assessed. Actual spinal canal enlargement was verified on postoperative CT images. Linear correlation analysis and Bland‒Altman analysis were used to evaluate correlation and agreement between the intraoperative and postoperative measurements.
The LOA at C5 measured with IOUS was 27.54 ± 3.12°, and it was 27.23 ± 3.02° on postoperative CT imaging. Linear correlation analysis revealed a significant correlation between IOUS and postoperative CT measurements (r = 0.88; p < 0.01). Bland-Altman plots showed good agreement between these two methods, with a mean difference of 0.30°. For other spinal canal expansion parameter measurements, correlation analysis showed a moderate to a high degree of correlation (p < 0.01), and Bland-Altman analysis indicated good agreement.
In conclusion, during the French-door cervical laminoplasty procedure, application of IOUS can accurately evaluate spinal canal expansion. This innovative method may be helpful in improving surgical accuracy by enabling the operator to measure and determine canal enlargement during surgery, leading to ideal clinical outcomes and fewer postoperative complications.
The use of intraoperative ultrasonography to assess spinal canal expansion following French-door cervical laminoplasty may improve outcomes for patients undergoing this procedure by providing more accurate measurements of spinal canal expansion.
• Spinal canal expansion after French-door cervical laminoplasty substantially influences operative prognosis; insufficient or excessive lamina opening may result in unexpected outcomes. • Prediction of spinal canal expansion during surgery was previously impracticable, but based on this study, intraoperative ultrasonography offers an innovative approach and strongly agrees with postoperative CT measurement. • Since this is the first research to offer real-time canal expansion guidance for cervical laminoplasty, it may improve the accuracy of the operation and produce ideal clinical outcomes with fewer postoperative complications.
探讨术中超声（IOUS）应用于评估行法式门颈椎板成形术（FDCL）患者椎管扩张的可行性和有效性。
前瞻性招募了 25 例因多节段退行性颈脊髓病而行 FDCL 的患者。使用三角函数推导了描述颈椎板成形术张开角（LOA）与颈椎板成形术张开大小、矢状椎管直径增加和椎管面积之间关系的公式。术中使用 IOUS 成像测量 LOA，并评估其他椎管参数。在术后 CT 图像上验证实际椎管扩大。采用线性相关分析和 Bland-Altman 分析评估术中与术后测量之间的相关性和一致性。
使用 IOUS 测量 C5 的 LOA 为 27.54±3.12°，术后 CT 成像为 27.23±3.02°。线性相关分析显示 IOUS 与术后 CT 测量值之间存在显著相关性（r=0.88；p<0.01）。Bland-Altman 图显示两种方法之间具有良好的一致性，平均差值为 0.30°。对于其他椎管扩张参数测量，相关性分析显示相关性为中度至高度（p<0.01），Bland-Altman 分析显示良好的一致性。
总之，在法式门颈椎板成形术中，应用 IOUS 可以准确评估椎管扩张。这种创新方法可以通过使术者在手术中测量和确定椎管扩大，从而提高手术的准确性，达到理想的临床效果并减少术后并发症，从而有助于提高手术的准确性。
在法式门颈椎板成形术后使用术中超声评估椎管扩张，可能通过更准确地测量椎管扩张，改善接受该手术患者的治疗效果。
法式门颈椎板成形术后椎管扩张对手术预后有显著影响；颈椎板张开不足或过度可能导致意外的结果。
手术中预测椎管扩张以前是不可行的，但基于本研究，术中超声提供了一种创新方法，并且与术后 CT 测量结果高度一致。
由于这是第一项为颈椎板成形术提供实时椎管扩张指导的研究，它可以提高手术的准确性，并产生理想的临床效果，减少术后并发症。
