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Inadequate spinal cord expansion in intraoperative ultrasound after decompression may predict neurological recovery of degenerative cervical myelopathy

  • Ultrasound
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Abstract

Objective

To compare the neurological recovery between patients with adequate and inadequate immediate spinal cord expansion after sufficient decompression in degenerative cervical myelopathy (DCM).

Methods

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.

Results

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.

Conclusions

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.

Key Points

• 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.

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Abbreviations

APD:

Anteroposterior diameter

DCM:

Degenerative cervical myelopathy

IOUS:

Intraoperative ultrasound

mJOA:

Modified Japanese Orthopedic Association

RR:

Recovery rate

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Funding

This study has received funding by the R&D Program of Guangzhou City (No. 201807010031, No. 201704030082), the Sanming Project of Medicine in Shenzhen (No. SZSM201911002), the Sun Yat-sen University Clinical Research 5010 Program (No. 2019009), the National Natural Science Foundation of China (No. 81972135), and the Clinical Research Foundation of The Seventh Affiliated Hospital of Sun Yat-sen University (No. ZSQYLCKYJJ 202018).

Author information

Author notes

  1. Guoliang Chen and Fuxin Wei contributed equally to this work.

Authors and Affiliations

  1. 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

    Guoliang Chen, Fuxin Wei, Liangyu Shi, Jiachun Li, Huachuan Wu & Shaoyu Liu

  2. 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

    Guoliang Chen, Huachuan Wu, Xizhe Liu & Shaoyu Liu

  3. Department of Ultrasound, The Seventh Affiliated Hospital, Sun Yat-sen University, No. 628 Zhenyuan Road, Shenzhen, 518107, People’s Republic of China

    Xianxiang Wang & Zuofeng Xu

  4. Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China

    Meng Wang

Authors
  1. Guoliang Chen
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  2. Fuxin Wei
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  3. Liangyu Shi
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  4. Jiachun Li
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  5. Xianxiang Wang
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  6. Meng Wang
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  10. Shaoyu Liu
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Corresponding authors

Correspondence to Zuofeng Xu or Xizhe Liu.

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Guarantor

The scientific guarantor of this publication is Shaoyu Liu, The Seventh Affiliated Hospital, Sun Yat-sen University.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise. No complex statistical methods were necessary for this paper.

Informed consent

Only if the study is on human subjects:

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

The Seventh Affiliated Hospital of Sun Yat-sen University Ethics Committee.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in “Chen G, Li J, Wei F, Ji Q, Sui W, Chen B, Zou X, Xu Z, Liu X, Liu S. 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. 2020 May 30;21(1):336. doi: 10.1186/s12891-020-03319-w. PMID: 32473626; PMCID: PMC7261379.

No overlaps.

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• performed at one institution

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Chen, G., Wei, F., Shi, L. et al. Inadequate spinal cord expansion in intraoperative ultrasound after decompression may predict neurological recovery of degenerative cervical myelopathy. Eur Radiol 31, 8478–8487 (2021). https://doi.org/10.1007/s00330-021-08000-x

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  • DOI: https://doi.org/10.1007/s00330-021-08000-x

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