Our Summary

This study looked at a method of assessing how well surgery to relieve pressure on an injured spinal cord (called decompression) has been done. Using real-time ultrasound during the operation (intraoperative ultrasound or IOUS) was compared to assessing the success of the surgery afterwards using MRI and CT scans.

This was done by going through the medical records of 51 patients who had this kind of surgery. The researchers found that in about 10% of the cases, the surgeons decided to do more decompression after initially thinking it was enough, based on the IOUS. When looking at the post-surgery MRI and CT scans, it was found that the decompression was enough in about 84% of the cases. In the remaining cases, either the decompression was not enough, or there was post-surgery swelling despite enough decompression.

The study found that patients with more severe injuries and larger lesions (damaged areas) on their spinal cord were more likely to have not enough decompression as seen on the post-surgery scans.

The study concluded that IOUS could be useful in addition to post-surgery MRI and CT scans for assessing decompression. But more research is needed, surgeons need more experience with this method, and they should be aware that swelling may continue after the surgery.

FAQs

  1. What is the method used to assess the success of spinal decompression surgery?
  2. How effective was intraoperative ultrasound (IOUS) in deciding whether more decompression was needed during the surgery?
  3. Based on the study, what factors could influence the success of the decompression surgery?

Doctor’s Tip

One helpful tip a doctor might tell a patient about spinal decompression is to discuss the use of intraoperative ultrasound during the surgery. This technique can help ensure that enough decompression is achieved to relieve pressure on the spinal cord and improve outcomes. Patients with more severe injuries and larger lesions may benefit from this additional assessment tool to ensure the best possible results from the surgery. It is important for surgeons to have experience with this method and to be aware that post-surgery swelling may still occur despite adequate decompression.

Suitable For

Patients who are typically recommended spinal decompression are those with spinal cord injuries, spinal stenosis, herniated discs, degenerative disc disease, sciatica, and other conditions that cause compression on the spinal cord or nerves. Additionally, patients with more severe injuries and larger lesions on their spinal cord may benefit from spinal decompression.

Timeline

Before spinal decompression:

  1. Patient experiences symptoms such as back pain, leg pain, numbness, tingling, weakness, and difficulty walking.
  2. Patient undergoes diagnostic tests such as MRI, CT scan, and X-rays to determine the cause of their symptoms.
  3. Surgeon recommends spinal decompression surgery to relieve pressure on the spinal cord or nerves.

During spinal decompression:

  1. Surgeon uses intraoperative ultrasound (IOUS) to assess the extent of decompression needed during the surgery.
  2. Surgeon performs the decompression surgery, which may involve removing bone or tissue pressing on the spinal cord or nerves.

After spinal decompression:

  1. Patient undergoes post-surgery MRI and CT scans to assess the success of the decompression surgery.
  2. Surgeon may decide to perform additional decompression if needed based on the imaging results.
  3. Patient may experience continued swelling or other complications post-surgery, which may require further treatment or monitoring.
  4. Patient undergoes physical therapy or rehabilitation to improve strength and mobility after the surgery.

What to Ask Your Doctor

Some questions a patient should ask their doctor about spinal decompression based on this study include:

  1. How will my surgeon determine if the decompression during surgery is sufficient?
  2. Will intraoperative ultrasound be used during my surgery to assess the decompression?
  3. What are the potential risks or complications if the decompression is not enough?
  4. How will my surgeon ensure that enough decompression is achieved, especially if I have a severe injury or large lesion on my spinal cord?
  5. How will my surgeon address any post-surgery swelling that may occur despite enough decompression?
  6. Are there any additional precautions or measures that will be taken to ensure the success of the decompression surgery?
  7. What is the experience level of my surgeon with using intraoperative ultrasound for assessing decompression?
  8. Are there any specific follow-up scans or tests that will be done to confirm the success of the decompression surgery?

Reference

Authors: Chryssikos T, Stokum JA, Ahmed AK, Chen C, Wessell A, Cannarsa G, Caffes N, Oliver J, Olexa J, Shea P, Labib M, Woodworth G, Ksendzovsky A, Bodanapally U, Crandall K, Sansur C, Schwartzbauer G, Aarabi B. Journal: Neurosurgery. 2023 Feb 1;92(2):353-362. doi: 10.1227/neu.0000000000002207. Epub 2022 Nov 23. PMID: 36637270