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

Chen, Guoliang; Wei, Fuxin; Shi, Liangyu; Wang, Xianxiang; Wang, Meng; Wu, Huachuan; Xu, Zuofeng; Liu, Xizhe; Liu, Shaoyu

doi:10.1007/s00330-021-08000-x

Cited by 15 publications

(17 citation statements)

References 35 publications

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“…All patients acquired sufficient decompression according to the classification based on IOUS described previously [21]. The mean mJOA score increased significantly from 11.66 ± 2.66 before surgery to 15.36 ± 1.40 at 12 months after surgery ( p < 0.05), and the mean mJOA score RR was 68.69 ± 20.22%.…”

Section: Resultsmentioning

confidence: 99%

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Potential of intraoperative ultrasonographic assessment of the spinal cord central echo complex in predicting postoperative neurological recovery of degenerative cervical myelopathy

Chen

et al. 2021

Euro J of Neurology

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Background and purpose:The spinal cord central echo complex (SCCEC) is a special ultrasonography-based intramedullary structure, but its clinical significance in degenerative cervical myelopathy (DCM) is undefined. This study aimed to explore the potential of the SCCEC in predicting postoperative neurological recovery in DCM.Methods: Thirty-two DCM patients who underwent intraoperative ultrasonographyguided French-door laminoplasty were prospectively enrolled. The modified Japanese Orthopaedic Association (mJOA) score was evaluated preoperatively and 12 months postoperatively. SCCEC width (SCCEC-W), and anteroposterior diameter (APD) and transverse diameter (TD) of the spinal cord were measured on transverse ultrasonographic images, while the tissue widths from anterior and posterior borders of the spinal cord to the SCCEC were measured on sagittal ultrasonographic images. The APD of the spinal cord and occupying rate of the spinal canal were measured on preoperative magnetic resonance imaging (MRI).Results: All patients achieved improvements in mJOA scores, with an average recovery rate (RR) of 68.69 ± 20.22%. Spearman correlation analysis revealed that SCCEC-W, and ratios between the SCCEC-W and APD/TD based on ultrasonography, correlated moderately with mJOA score RR, with coefficients of −0.527, −0.605 and −0.514, respectively.The ratio between SCCEC-W and ultrasonographic TD correlated moderately with preoperative APD of the spinal cord. The MRI measurements and ultrasonography-based tissue widths showed no significant correlation with mJOA score RR. Conclusions:The SCCEC may have predictive potential as an intraoperative indicator of neurological recovery in treating DCM. SCCEC-W may be related to spinal cord compression in DCM.

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Section: Resultsmentioning

confidence: 99%

“…All patients acquired sufficient decompression according to the classification based on IOUS described previously [21].…”

Section: Re Sultsmentioning

confidence: 99%

Potential of intraoperative ultrasonographic assessment of the spinal cord central echo complex in predicting postoperative neurological recovery of degenerative cervical myelopathy

Chen

et al. 2021

Euro J of Neurology

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“…I O US i mage s we re u s ed f o r t h e calculation of the MSCC after sufficient decompression and the patients were divided into adequate (MSCC ≥ 0.95) and inadequate (MSCC < 0.95) expansion groups as per the MSCC. They determined that the recovery rate of the mJOA score in the inadequate expansion group was much lower than that of the adequate expansion group www.jcorth.com Marathe N et al [63].…”

Section: Role Of Intraoperative Ultrasound (Ious)mentioning

confidence: 99%

Current Trends in Degenerative Cervical Myelopathy

Marathe,

Bali,

Prabhu

et al. 2022

Jcorth

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Advances in patient selection, surgical techniques, and postoperative care have facilitated spine surgeons to manage complex spine cases with shorter operative times, reduced hospital stay and improved outcomes. We focus this article on a few areas which have shown maximum developments in management of degenerative cervical myelopathy and also throw a glimpse into the future ahead. Imaging modalities, surgical decision making, robotics and neuro-navigation, minimally invasive spinal surgery, motion preservation, use of biologics are few of them. Through this review article, we hope to provide the readers with an insight into the present state of art in cervical myelopathy and what the future has in store for us.

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“…Bilateral gutters were created as hinges at the border of the laminae and facets. After the halves of the laminae were elevated and fixed to bilateral skin provisionally, normal saline was infused to form an acoustic window, then a linear array transducer of IOUS (M9Expert; Mindray Medical International Limited, Shenzhen, China) was used to observe the spinal cord and record the images [7,9]. If residual compression was observed, further decompression under IOUS guidance was done.…”

Section: Image Acquisitionmentioning

confidence: 99%

“…However, conventional MRI consisting of T1w and T2w anatomical images offer only limited insight into pathological tissue changes, prompting the development of more advanced MRI sequences and emerging methods of imaging and electrophysiology that assess specific features of microstructure and tissue injury for the management of DCM [4,5]. Recently, intraoperative ultrasonography (IOUS) was performed to evaluate and guide surgical decompression, and some IOUS-derived metrics were confirmed to be significantly correlated with the neurological function in DCM [7,8]. Like ISI on T2W MRI, the spinal cord can manifest as hyperechogenicity on IOUS, with the same segment of ISI on T2W MRI [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Comparative Intra- and Inter-observer Reliability of Two Methods for Evaluating Intraoperative Ultrasonography-based Spinal Cord Hyperechogenicity Intensity in Degenerative Cervical Myelopathy

Chen

et al. 2022

Preprint

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Objective: To acquire a higher-reliability method, and compare the in-observer and inter-observer reliability of two methods in evaluating the hyperechoic intensity of spinal cord ultrasound in degenerative cervical myelopathy (DCM).Materials and Methods: Totally 28 patients (20 males and 8 females) who had been followed up for 12 months were included. Their mean age at surgery was 61.2±10.8 years and the average symptom duration was 23.36±22.11 months. The gray values of circles 1, 2 and 3 were recorded as Gcompression, Gnorml and Gsac, respectively. The gray value ratio (GVR) was calculated as follows: GVR-A= Gcompression/Gnorml (method A), and GVR-B= Gcompression/Gsac (method B). The in-observer and inter-observer reliabilities of the two methods were compared. It is generally believed a reliability coefficient < 0.40 and > 0.75 indicate poor and good reliability respectively. The images-based GVR-B using this protocol demonstrates higher inter- and intraobserver reliabilities than GVR-A, and can be used as the basis for prognostic prediction and future studies.Results: All examination acquisitions were successfully completed. GVR-A averaged 2.043 (0.318–5.56), and GVR-B averaged 0.578(0.06–1.41). GVR-B has better repeatability of gray value measurement, smaller RSD% (0.298 vs. 0.32) and larger inter-group correlation coefficient compared with GVR-A. The mean value (MD) of the GVR difference calculated by GVR-B between the two clinicians was closer to 0.Conclusions: For DCM patients routinely using ultrasound for real-time cord visualization during spinal cord decompression by French-door laminoplasty, the images-based GVR-B using this protocol demonstrates better inter- and intraobserver reliabilities compared with GVR-A.

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

Cited by 15 publications

References 35 publications

Potential of intraoperative ultrasonographic assessment of the spinal cord central echo complex in predicting postoperative neurological recovery of degenerative cervical myelopathy

Potential of intraoperative ultrasonographic assessment of the spinal cord central echo complex in predicting postoperative neurological recovery of degenerative cervical myelopathy

Current Trends in Degenerative Cervical Myelopathy

Comparative Intra- and Inter-observer Reliability of Two Methods for Evaluating Intraoperative Ultrasonography-based Spinal Cord Hyperechogenicity Intensity in Degenerative Cervical Myelopathy

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