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Intraoperative cervical epidurography: a simple modality for assessing the adequacy of decompression during anterior
Nedal Hejazi1, Alfred Witzmann, Werner Hassler
1Department of Neurosurgery, Landeskrankenhaus Feldkirch, Academic Hospital of the University of Innsbruck, Austria. Hejazi@web.de
Object:
Intraoperative cervical epidurography (ICE) was used during anterior cervical procedures to assess the success of bone resection and indicate the need for immediate correction in the event of inadequate decompression.
Methods:
The adequacy of decompression was assessed by the operating neurosurgeon who performed ICE after anterior microdiscectomy with exposure of the dura mater. If the decompression was deemed inadequate, additional bone was removed using a high-speed drill. Epidurography was conducted after each subsequent decompression until adequate bone removal was achieved. This was undertaken in 39 patients undergoing anterior cervical procedures. Nine patients underwent corpectomy, 21 one-level, and nine two-level discectomy. The ICE revealed insufficient resections requiring additional bone removal in 14 (36%) of the 39 patients.
Conclusions:
The goal of ICE is to ensure adequate decompression, and if such has not been achieved, to allow for additional immediate bone excision. Furthermore, ICE provides additional real-time control of the position of cages and screws to avoid dural tear or spinal cord compression. Because of this immediate feedback, the success rate of anterior cervical procedures can be improved. The advantages of this modality include real-time assessment, low cost, simplicity, and speed.