Extent of Spinal Cord Decompression in Motor Complete (American Spinal Injury Association Impairment Scale Grades A and B) Traumatic Spinal Cord Injury Patients: Post-Operative Magnetic Resonance Imaging Analysis of Standard Operative Approaches

Bizhan Aarabi, Joshua Olexa, Timothy Chryssikos, Samuel M. Galvagno, David S. Hersh, Aaron Wessell, Charles Sansur, Gary Schwartzbauer, Kenneth Crandall, Kathirkamanathan Shanmuganathan, J. Marc Simard, Harry Mushlin, Mathew Kole, Elizabeth Le, Nathan Pratt, Gregory Cannarsa, Cara D. Lomangino, Maureen Scarboro, Carla Aresco, Brian Curry

Research output: Contribution to journalArticlepeer-review

Abstract

Although decompressive surgery following traumatic spinal cord injury (TSCI) is recommended, adequate surgical decompression is rarely verified via imaging. We utilized magnetic resonance imaging (MRI) to analyze the rate of spinal cord decompression after surgery. Pre-operative (within 8 h of injury) and post-operative (within 48 h of injury) MRI images of 184 motor complete patients (American Spinal Injury Association Impairment Scale [AIS] grade A = 119, AIS grade B = 65) were reviewed to verify spinal cord decompression. Decompression was defined as the presence of a patent subarachnoid space around a swollen spinal cord. Of the 184 patients, 100 (54.3%) underwent anterior cervical discectomy and fusion (ACDF), and 53 of them also underwent laminectomy. Of the 184 patients, 55 (29.9%) underwent anterior cervical corpectomy and fusion (ACCF), with (26 patients) or without (29 patients) laminectomy. Twenty-nine patients (16%) underwent stand-alone laminectomy. Decompression was verified in 121 patients (66%). The rates of decompression in patients who underwent ACDF and ACCF without laminectomy were 46.8% and 58.6%, respectively. Among these patients, performing a laminectomy increased the rate of decompression (72% and 73.1% of patients, respectively). Twenty-five of 29 (86.2%) patients who underwent a stand-alone laminectomy were found to be successfully decompressed. The rates of decompression among patients who underwent laminectomy at one, two, three, four, or five levels were 58.3%, 68%, 78%, 80%, and 100%, respectively (p < 0.001). In multi-variate logistic regression analysis, only laminectomy was significantly associated with successful decompression (odds ratio 4.85; 95% confidence interval 2.2-10.6; p < 0.001). In motor complete TSCI patients, performing a laminectomy significantly increased the rate of successful spinal cord decompression, independent of whether anterior surgery was performed.

Original languageEnglish (US)
Pages (from-to)862-876
Number of pages15
JournalJournal of neurotrauma
Volume36
Issue number6
DOIs
StatePublished - Mar 15 2019
Externally publishedYes

Keywords

  • ASIA impairment scale
  • MRI
  • decompression
  • spinal cord injury
  • trauma

ASJC Scopus subject areas

  • Clinical Neurology

Fingerprint

Dive into the research topics of 'Extent of Spinal Cord Decompression in Motor Complete (American Spinal Injury Association Impairment Scale Grades A and B) Traumatic Spinal Cord Injury Patients: Post-Operative Magnetic Resonance Imaging Analysis of Standard Operative Approaches'. Together they form a unique fingerprint.

Cite this