Contrast-Enhanced Ultrasound Perfusion Imaging of the Spinal Cord Before and After Surgical Decompression for Cervical Spondylotic Myelopathy

BACKGROUND AND OBJECTIVES: Identifying prognostic factors and biomarkers to predict postoperative outcomes in patients surgically treated for cervical spondylotic myelopathy (CSM) is an area of ongoing research. While intraoperative spinal cord perfusion changes are believed to play a role, few imaging modalities can readily quantify spinal cord perfusion intraoperatively. Contrast-enhanced ultrasound (CEUS) shows promise in evaluating neural structure perfusion but has only been demonstrated postdecompression. Capturing predecompression and postdecompression CEUS spinal cord perfusion data is essential to understanding perfusion's role in recovery after surgical decompression for CSM. We aimed to develop a technique for acquiring CEUS spinal cord perfusion predecompression and postdecompression in patients with CSM and to correlate perfusion data with preoperative and long-term neurologic status. METHODS: Sixteen adult participants undergoing elective posterior cervical decompression for CSM were enrolled. Before and immediately after decompression, a 10 µL/kg bolus of DEFINITY contrast was administered intravenously. The spinal cord was imaged in the midline sagittal plane for 120 seconds. CEUS data were analyzed using time intensity curve analyses where wash-in-time (WIT), appearance-time, and time-to-peak were calculated. Demographics, neurologic examinations, and modified Japanese Orthopedic Association scores were collected preoperatively and postoperatively. RESULTS: The CEUS technique for predecompression and postdecompression spinal cord perfusion imaging was feasible and void of complications. WIT values significantly correlated with neurologic status, as measured by modified Japanese Orthopedic Association scores. Specifically, WIT values correlated with preoperative (slope = −0.20, 95% CI [−0.37, −0.02], F [1,14] = 6.00, P = .028), 1 month postoperative (slope = −0.27, 95% CI [−0.47, −0.06], F [1,14] = 7.56, P = .016), and 6 month postoperative scores (slope = −0.28, 95% CI [−0.49, −0.07], F [1,14] = 8.08, P = .013). CONCLUSION: CEUS can acquire spinal cord perfusion data before and after decompression in patients with CSM. This modality shows promise in elucidating the role of perfusion in CSM recovery and may serve as a prognostic tool.