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

Guoliang Chen,Shaoyu Liu,Bailing Chen,Zuofeng Xu,Jiachun Li,Wenyuan Sui,Xizhe Liu,Qiao Ji,Fuxin Wei,Xuenong Zou

doi:10.1186/s12891-020-03319-w

Abstract

BackgroundTo study the correlation of neurological function in degenerative cervical myelopathy (DCM) patients with quantitative assessment of spinal cord compression and impairment by intraoperative ultrasound imaging (IOUSI).MethodsTwenty-three patients who underwent French-Door laminoplasty for multilevel DCM were followed for 6 months. Modified Japanese Orthopaedic Association (mJOA) score and cervical MRI were assessed before surgery and at postoperative 6 months. IOUS, used to guide decompression, were recorded. The anteroposterior diameter (APD) and the gray values of the IOUSI hyperechogenicity of the midsagittal IOUSI at the narrowest level and at the lesion-free level, and the APD and traverse diameter at the traverse maximum compression level of IOUSI were measured. Maximum spinal cord compression (MSCC), compression rate (CR), and IOUSI gray value ratio (Rgray) were calculated. The appearance of preoperative T2W MRI increased signal intensity (ISI), and the signal change rate (SCR) on postoperative T2W MRI of 9 patients were also measured and calculated, and compared with that of IOUSI hyperechogenicity.ResultsAverage mJOA score increased significantly from 11.57 ± 2.67 before surgery to 15.39 ± 1.50 at 6 months after surgery, with an average recovery rate (RR) of 71.11 ± 22.81%. The difference between the appearance of preoperative T2W MRI ISI and IOUSI hyperechogenicity was not significant. Spearman correlation analysis found that the IOUSI Rgray were negatively correlated with the RR of mJOA score with a coefficient of − 0.77, and the IOUSI Rgray was not correlated with the postoperative MRI SCR.ConclusionsIn DCM patients, the gray values of IOUSI can be measured accurately. The IOUSI Rgray correlated with postoperative neurological recovery significantly.

Highlights

To study the correlation of neurological function in degenerative cervical myelopathy (DCM) patients with quantitative assessment of spinal cord compression and impairment by intraoperative ultrasound imaging (IOUSI)
Spearman correlation analysis found that the IOUSI Rgray were negatively correlated with the recovery rate (RR) of Modified Japanese Orthopaedic Association (mJOA) score with a coefficient of − 0.77, and the IOUSI Rgray was not correlated with the postoperative Magnetic resonance imaging (MRI) signal change rate (SCR)
The IOUSI Rgray correlated with postoperative neurological recovery significantly

Summary

Introduction

To study the correlation of neurological function in degenerative cervical myelopathy (DCM) patients with quantitative assessment of spinal cord compression and impairment by intraoperative ultrasound imaging (IOUSI). Magnetic resonance imaging (MRI), which can indicate the degree of spinal stenosis and reveal the pathological status of the spinal cord in detail, is an important and effective method for the diagnosis and prediction of DCM [4, 5]. IOUS detected the real status of the spinal cord after decompression, resulting in a measurement more similar to the postoperative situation. We speculate that those intraoperative ultrasonic manifestations can be used to predict the postoperative neurological function in DCM. In order to verify our hypothesis, we conducted a clinical study with short-term follow-up to analyze the correlation between short-term outcome of French-door laminoplasty (FDL) and intraoperative ultrasonic manifestations

Methods

Results

Discussion

Conclusion