Intraoperative Ultrasound-Guided Posterior Cervical Laminectomy for Degenerative Cervical Myelopathy

Objective We present our experience with routine intraoperative ultrasound (IOUS)–guided posterior cervical laminectomy (PCL) in patients with degenerative cervical myelopathy (DCM), describe the technique used, and describe relevant IOUS findings that may impact the surgical procedure. Methods Three illustrative cases are presented of patients (age range, 67–79 years) who underwent PCL with IOUS guidance and instrumented fusion for DCM. Intraoperative standard B-mode images were obtained with a linear array 6.6- to 13.3-MHz transducer. Results Excellent high-resolution IOUS view of the spinal cord and nerve roots was obtained in every case after laminectomy. IOUS had a relevant intraoperative impact in all cases, leading to extended decompression of focal residual compression, confirmation of posterior shift of the spinal cord from anteriorly located structures, and final confirmation of sufficient decompression by visualization of symmetric and rhythmic cord pulsations. Conclusions IOUS is a poorly described yet easy-to-use and very effective tool for guidance and confirmation of adequate posterior decompression of the cervical spinal cord and nerve roots during PCL. Routinely using IOUS-guided decompression for PCL in patients with myelopathy will help avoid residual compression of neural elements and might be beneficial for functional outcome.