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Percutaneous Ultrasonographic Evaluation of the Spinal Cord After Cervical Laminoplasty

Kowatari, Kenji MD, PhD*; Nitobe, Taisuke MD, PhD; Ono, Atsushi MD, PhD*; Tanaka, Toshihiro MD, PhD*; Itabashi, Taito MD, PhD*; Ishibashi, Yasuyuki MD, PhD*

doi: 10.1097/BRS.0000000000000209
Cervical Spine

Study Design. Prospective cohort study.

Objective. To investigate the dynamic changes of cervical spinal cord with postural change after cervical laminoplasty by means of postoperative percutaneous ultrasonography.

Summary of Background Data. Many reports have been published about intraoperative ultrasonographic evaluation of the spinal cord. Few reports have described postoperative diagnostic ultrasonographic findings of the spinal cord after a previous laminectomy. To date, there are no studies that have examined the changes in pulsation pattern and intensity of the spinal cord at different body positions with percutaneous ultrasonography.

Methods. Thirty-three patients after cervical laminoplasty were evaluated postoperatively by percutaneous ultrasonography of the cervical spinal cord. Ultrasonographic images were obtained from 5 different body positions sitting with neck neutral, sitting with neck flexion, sitting with neck extension, prone, and supine position.

Results. The pattern and intensity of cervical spinal cord pulsation and the anteroposterior position of the cervical spinal cord changed according to posture. Pulsation of the cervical spinal cord was more common in sitting position, whereas wave motion was more common in supine position.

Supine, prone, sitting with neck extension, sitting with neck neutral, and sitting with neck flexion position were ranked in descending order of spinal cord pulsating intensity. Subarachnoidal space ventral to the cervical spinal cord was more likely to appear in the supine position.

Conclusion. Assuming that good spinal cord pulsation represents good spinal circulation, these results suggest that the supine position will provide the most favorable condition for recovery of the cervical spinal cord.

Level of Evidence: 2

We studied the dynamic change of cervical spinal cord according to postural change with postoperative ultrasonography. There were significant changes in pattern, intensity, and position of the cervical spinal cord according to postural change, especially in the supine position.

*Department of Orthopaedic Surgery, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan; and

Department of Orthopaedic Surgery, Seihoku Chuo Hospital, Goshogawara, Aomori, Japan.

Address correspondence and reprint requests to Kenji Kowatari, MD, PhD, Department of Orthopaedic Surgery, Hirosaki University School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori 036-8562, Japan; E-mail: k_kowaken@hotmail.com

Acknowledgment date: October 15, 2013. First revision date: December 6, 2013. Acceptance date: December 29, 2013.

The device(s)/drug(s) is/are FDA approved or approved by corresponding national agency for this indication.

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

© 2014 by Lippincott Williams & Wilkins