A new technique of intraoperative epidurography for assessing the adequacy of decompression in anterior cervical surgical procedures / 中华骨科杂志

ABSTRACT

Objective To assess the adequacy of decompression immediately in anterior cervical surgical procedures with epidurography, and to prevent from leaving compressive materials. Methods After completing primary decompression of anterior cervical intervertebral space by discectomy or corpectomy, posterior longitudinal ligaments were incised or resected, 5-10 ml Omnipaque 300 contrast medium was injected into upper and lower segments of decompressed area through a soft 18# injection needle. Distribution of the contrast medium in front of dura mater was observed by fluoroscopy so as to identify whether the spinal cords were decompressed completely. 64 patients suffered from cervical spondylotic myelopathy, and spinal cords were compressed respectively by giant intervertebral disc prolapse, osteophyte or short segmental OPLL. Intraoperative epidurography was performed after primary anterior decompression. If contrast medium in front of dura mater was discontinued by fluoroscopy, incomplete decompression was judged. 39 of 64 patients were followed up after operation, and in 18 patients of them MRI were taken within 1-12 weeks after operation. Neurological function was compared between preoperation, immediate postoperation and final follow-up by means of JOA scores. Results After completing primary decompression, epidurographs showed that the contrast medium were continuous in front of dura mater in 49 cases(77%), 11 patients of them were examined by MRI during follow-up and the images indicated that cervical cords were free of compression. In 15 cases (23%), the contrast medium was not continuous in front of dura mater, then decompression was performed further until the contrast medium no any interruption. 7 patients of them were confirmed by MRI that cervical cords were no more compressed. 39 patients were followed up postoperatively with a mean follow-up of 13 months. Neurological function was recovered immediately after operation by 52% and 61% at final follow-up. No neurological deficit progressed in all of them. Conclusion Intraoperative epidurography is effective and safe for assessment of decompression during anterior cervical surgical procedures.