Increased blood ﬂow of spinal cord lesion after decompression improves neurological recovery of degenerative cervical myelopathy: an intraoperative ultrasonography-based prospective cohort study

International Journal of Surgery, 2023 · DOI: http://dx.doi.org/10.1097/JS9.0000000000000361 · Published: March 31, 2023

Neurology Surgery Spinal Disorders

Simple Explanation

This study investigates the relationship between spinal cord blood flow after surgical decompression and neurological recovery in patients with degenerative cervical myelopathy (DCM). Surgical decompression is a common treatment for DCM, but the reasons for neurological improvement are not fully understood. The researchers used intraoperative contrast-enhanced ultrasonography (CEUS) to assess spinal cord blood flow after decompression. They then correlated these blood flow measurements with the patients' neurological recovery rates. The study found that patients with increased blood flow to the spinal cord lesion immediately after surgery tended to have greater neurological recovery. This suggests that improved blood flow plays a key role in the recovery process following decompression for DCM.

Study Duration

March 2019 and May 2020

Participants

29 patients with multilevel DCM

Evidence Level

Prospective cohort study

Key Findings

1
Intraoperative CEUS can clearly reflect spinal cord blood flow in DCM patients.
2
Patients with favorable neurological recovery had a greater increased blood flow signal in the compressive spinal cord segment after decompression.
3
Increased blood perfusion of the spinal cord lesion immediately after surgical decompression tended to lead to greater neurological recovery.

Research Summary

The study aimed to evaluate spinal cord blood flow status after sufficient decompression by intraoperative contrast-enhanced ultrasonography (CEUS) and to analyze the correlation between neurological recovery and postdecompressive spinal cord blood perfusion in DCM. Twenty-nine patients were included in the study. The mJOA scores were significantly improved in all patients from 11.2 ± 2.1 preoperatively to 15.0 ± 1.1 at 12 months postoperatively, with an average recovery rate of 64.9 ± 16.2%. In DCM, intraoperative CEUS can clearly reflect spinal cord blood flow. Patients with increased blood perfusion of the spinal cord lesion immediately after surgical decompression tended to achieve greater neurological recovery.

Practical Implications

Improved Understanding of Recovery Mechanisms

The study provides insights into the mechanisms of neurological recovery following surgical decompression for DCM, highlighting the importance of spinal cord blood flow.

Intraoperative Monitoring Tool

Intraoperative CEUS may be a valuable tool for monitoring spinal cord blood flow during decompression surgery, potentially helping to optimize surgical outcomes.

Targeted Therapies

The findings suggest that therapies aimed at improving spinal cord blood flow could enhance neurological recovery in DCM patients.

Study Limitations

1
The mJOA score as the only neurological indicator
2
Existing preoperative cervical lamina or postoperative hydroxyapatite spacer can block ultrasonic waves
3
The sample size was small

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