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European Spine Journal

, Volume 27, Issue 11, pp 2763–2771 | Cite as

Percutaneous ultrasonographic evaluation of the spinal cord after cervical laminoplasty: time-dependent changes

  • Yoshiharu NakayaEmail author
  • Atsushi Nakano
  • Kenta Fujiwara
  • Takashi Fujishiro
  • Sachio Hayama
  • Toma Yano
  • Masashi Neo
Original Article

Abstract

Purpose

The first purpose of this study is to confirm whether the spinal cord and the surrounding tissues can be visualized clearly after laminoplasty using percutaneous ultrasonography. And second purpose is to evaluate the changes in the status of the spinal cord over time.

Methods

Fifty patients who underwent cervical laminoplasty with suture anchors were evaluated using intraoperative ultrasonography and postoperative (1 week, 2 weeks, 3 months, 6 months, and 1 year) percutaneous ultrasonography. We classified the decompression status of the spinal cord into three grades and the pattern of the spinal cord pulsation into six categories. Clinical outcomes were evaluated using the Japanese Orthopaedic Association Score for cervical myelopathy, and the recovery rate was calculated.

Results

In all cases and all periods, we could observe the status of the spinal cord using percutaneous ultrasonography after cervical laminoplasty. The decompression status of the spinal cord improved until 3 months postoperatively, and the clinical outcomes improved up to 6 months postoperatively. Although the pulsation pattern of the spinal cord varied in each individual and in each period, spinal pulsation itself was observed in all cases and all periods, except one, when an epidural hematoma caused quadriplegia and a revision surgery was needed. Decompression status and pulsation pattern of the spinal cord were not associated with clinical outcomes as far as pulsation was observed.

Conclusions

Percutaneous ultrasonography was very useful method to evaluate the postoperative status of the spinal cord, particularly in the diagnosis of the postoperative epidural hematoma.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

Keywords

Cervical laminoplasty Percutaneous ultrasonography Epidural hematoma Spinal cord dynamics 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the ethics review board of our institution; Osaka medical college (No. 2403).

Informed consent

For this type of study formal consent is not required according to the Japanese ethical guideline for clinical research. Instead, we provided the patients with the opportunity to opt out on website.

Supplementary material

Supplementary material 1 (MOV 69088 kb)

Supplementary material 2 (MOV 51776 kb)

Supplementary material 3 (MOV 74605 kb)

586_2018_5752_MOESM4_ESM.pptx (70.3 mb)
Supplementary material 4 (PPTX 71943 kb)

References

  1. 1.
    Dohrmann GJ, Rubin JM (1982) Intraoperative ultrasound imaging of the spinal cord: syringomyelia, cysts, and tumors—a preliminary report. Surg Neurol 18:395–399CrossRefGoogle Scholar
  2. 2.
    Jokich PM, Rubin JM, Dohrmann GJ (1984) Intraoperative ultrasonic evaluation of spinal cord motion. J Neurosurg 60:707–711.  https://doi.org/10.3171/jns.1984.60.4.0707 CrossRefPubMedGoogle Scholar
  3. 3.
    Quencer RM, Montalvo BM (1984) Normal intraoperative spinal sonography. AJR Am J Roentgenol 143:1301–1305.  https://doi.org/10.2214/ajr.143.6.1301 CrossRefPubMedGoogle Scholar
  4. 4.
    Kawakami N, Mimatsu K, Kato F et al (1994) Intraoperative ultrasonographic evaluation of the spinal cord in cervical myelopathy. Spine 19:34–41.  https://doi.org/10.1097/00007632-199401000-00007 CrossRefPubMedGoogle Scholar
  5. 5.
    Mihara H, Kondo S, Takeguchi H et al (2007) Spinal cord morphology and dynamics during cervical laminoplasty: evaluation with intraoperative sonography. Spine 32:2306–2309.  https://doi.org/10.1097/BRS.0b013e318155784d CrossRefPubMedGoogle Scholar
  6. 6.
    Naruse T, Yanase M, Takahashi H et al (2009) Prediction of clinical results of laminoplasty for cervical myelopathy focusing on spinal cord motion in intraoperative ultrasonography and postoperative magnetic resonance imaging. Spine 34:2634–2641.  https://doi.org/10.1097/BRS.0b013e3181b46c00 CrossRefPubMedGoogle Scholar
  7. 7.
    Seichi A, Chikuda H, Kimura A et al (2010) Intraoperative ultrasonographic evaluation of posterior decompression via laminoplasty in patients with cervical ossification of the posterior longitudinal ligament: correlation with 2-year follow-up results. J Neurosurg Spine 13:47–51.  https://doi.org/10.3171/2010.3.SPINE09680 CrossRefPubMedGoogle Scholar
  8. 8.
    Kimura A, Seichi A, Inoue H et al (2012) Ultrasonographic quantification of spinal cord and dural pulsations during cervical laminoplasty in patients with compressive myelopathy. Eur Spine J 21:2450–2455.  https://doi.org/10.1007/s00586-012-2430-9 CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Mihara H, Kondo S, Katoh S et al (2016) Intraoperative neural mobility and postoperative neurological recovery in anterior cervical decompression surgery: evaluation with intraoperative sonography. Clin Spine Surg 29:212–216.  https://doi.org/10.1097/BSD.0b013e318271b4e0 CrossRefPubMedGoogle Scholar
  10. 10.
    Matsuyama Y, Kawakami N, Yanase M et al (2004) Cervical myelopathy due to OPLL: clinical evaluation by MRI and intraoperative spinal sonography. J Spinal Disord Tech 17:401–404CrossRefGoogle Scholar
  11. 11.
    Miyata M, Neo M, Fujibayashi S et al (2008) Double-door cervical laminoplasty with the use of suture anchors: technical note. J Spinal Disord Tech 21:575–578.  https://doi.org/10.1097/BSD.0b013e31815cb1ba CrossRefPubMedGoogle Scholar
  12. 12.
    Fujishiro T, Nakano A, Baba I et al (2017) Double-door cervical laminoplasty with suture anchors: evaluation of the clinical performance of the constructs. Eur Spine J 26:1121–1128.  https://doi.org/10.1007/s00586-016-4666-2 CrossRefPubMedGoogle Scholar
  13. 13.
    Kowatari K, Nitobe T, Ono A et al (2014) Percutaneous ultrasonographic evaluation of the spinal cord after cervical laminoplasty. Spine 39:E434–E440.  https://doi.org/10.1097/BRS.0000000000000209 CrossRefPubMedGoogle Scholar
  14. 14.
    Hirabayashi K, Watanabe K, Wakano K et al (1983) Expansive open-door laminoplasty for cervical spinal stenotic myelopathy. Spine 8:693–699CrossRefGoogle Scholar
  15. 15.
    Aono H, Ohwada T, Hosono N et al (2011) Incidence of postoperative symptomatic epidural hematoma in spinal decompression surgery. J Neurosurg Spine 15:202–205.  https://doi.org/10.3171/2011.3.SPINE10716 CrossRefPubMedGoogle Scholar
  16. 16.
    Hatta Y, Shiraishi T, Hase H et al (2005) Is posterior spinal cord shifting by extensive posterior decompression clinically significant for multisegmental cervical spondylotic myelopathy? Spine 30:2414–2419CrossRefGoogle Scholar
  17. 17.
    Miura J, Doita M, Miyata K et al (2009) Dynamic evaluation of the spinal cord in patients with cervical spondylotic myelopathy using a kinematic magnetic resonance imaging technique. J Spinal Disord Tech 22:8–13.  https://doi.org/10.1097/BSD.0b013e31815f2556 CrossRefPubMedGoogle Scholar
  18. 18.
    Fujiwara Y, Manabe H, Harada T et al (2017) Extraordinary positional cervical spinal cord compression in extension position as a rare cause of postoperative progressive myelopathy after cervical posterior laminoplasty detected using the extension/flexion positional CT myelography: one case after laminectomy following failure of a single-door laminoplasty/one case after double-door laminoplasty without interlaminar spacers. Eur Spine J 26:170–177.  https://doi.org/10.1007/s00586-017-5001-2 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Orthopedic SurgeryOsaka Medical CollegeOsakaJapan

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