Abstract
Although decompressive surgery following traumatic spinal cord injury (TSCI) is recommended, adequate surgical decompression is rarely verified via imaging. We utilized magnetic resonance imaging (MRI) to analyze the rate of spinal cord decompression after surgery. Pre-operative (within 8 h of injury) and post-operative (within 48 h of injury) MRI images of 184 motor complete patients (American Spinal Injury Association Impairment Scale [AIS] grade A = 119, AIS grade B = 65) were reviewed to verify spinal cord decompression. Decompression was defined as the presence of a patent subarachnoid space around a swollen spinal cord. Of the 184 patients, 100 (54.3%) underwent anterior cervical discectomy and fusion (ACDF), and 53 of them also underwent laminectomy. Of the 184 patients, 55 (29.9%) underwent anterior cervical corpectomy and fusion (ACCF), with (26 patients) or without (29 patients) laminectomy. Twenty-nine patients (16%) underwent stand-alone laminectomy. Decompression was verified in 121 patients (66%). The rates of decompression in patients who underwent ACDF and ACCF without laminectomy were 46.8% and 58.6%, respectively. Among these patients, performing a laminectomy increased the rate of decompression (72% and 73.1% of patients, respectively). Twenty-five of 29 (86.2%) patients who underwent a stand-alone laminectomy were found to be successfully decompressed. The rates of decompression among patients who underwent laminectomy at one, two, three, four, or five levels were 58.3%, 68%, 78%, 80%, and 100%, respectively (p < 0.001). In multi-variate logistic regression analysis, only laminectomy was significantly associated with successful decompression (odds ratio 4.85; 95% confidence interval 2.2–10.6; p < 0.001). In motor complete TSCI patients, performing a laminectomy significantly increased the rate of successful spinal cord decompression, independent of whether anterior surgery was performed.
Highlights
Investigators have shown that continued spinal cord compression (SCC) following experimental or traumatic spinal cord injury (TSCI) negatively affects neurological outcome, including motor and overall functional status.[1,2,3,4,5,6] Magnetic resonance imaging (MRI) and computed tomography (CT) myelogram remain the current standards for demonstrating SCC.[7]
Surgical management of subaxial cervical spine fracture dislocations was compatible with the scheme used in the randomized prospective trial of Vaccaro and colleagues[9] and the management algorithm of Dvorak and colleagues[27] We reviewed post-operative CT and MRI studies in order to determine the surgical technique
We examined 13 variables to assess whether they could in isolation or in regression models influence the achievement of successful decompression of a severely contused and swollen spinal cord across multiple motion segments (Table 1)
Summary
Investigators have shown that continued spinal cord compression (SCC) following experimental or traumatic spinal cord injury (TSCI) negatively affects neurological outcome, including motor and overall functional status.[1,2,3,4,5,6] Magnetic resonance imaging (MRI) and computed tomography (CT) myelogram remain the current standards for demonstrating SCC.[7]. The role of decompression following TSCI is widely acknowledged, we argue that research into the surgical management of TSCI and its long-term outcome is potentially confounded by lack of postoperative confirmation of actual decompression following operative intervention Without such studies, the exact definition of ‘‘decompression’’ remains uncertain, and as a result, the most effective techniques for achieving it remain unclear.[7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26]
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