Dynamic Compression of the Spinal Cord by Paraspinal Muscles following Cervical Laminectomy: Diagnosis Using
Linton T Evans1, S Scott Lollis1
1Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.
Abstract:
Introduction. Flexion-extension, or kinematic, MRI has been used to identify dynamic spondylotic spinal cord compression not seen with traditional static MRI. The use of kinematic MRI to diagnose postoperative complications, specifically dynamic compression, is not as well documented. The authors describe a case of dynamic spinal cord compression by the paraspinal muscles causing worsening myelopathy following cervical laminectomy. This was only diagnosed with flexion-extension MRI. Methods. The patient was a 90-year-old male presenting to the neurosurgery clinic with functional decline and cervical spondylotic myelopathy. Results. A multilevel laminectomy was performed. Following surgery the patient had progressive weakness and worsening myelopathy. No active cord compression was seen on multiple MRIs obtained in a neutral position, and flexion-extension X-rays did not show instability. A kinematic MRI demonstrated dynamic compression of the spinal cord only during neck extension, by the paraspinal muscles. To relieve the compression, the patient underwent an instrumented fusion, with cross-links used to buttress the paraspinal muscles away from the cord. This resulted in neurologic improvement. Conclusions. We describe a novel case of spinal cord compression by paraspinal muscles following cervical laminectomy. In individuals with persistent myelopathy or delayed neurologic decline following posterior decompression, flexion-extension MRI may prove useful in diagnosing this potential complication.
Insights
Dynamic spinal cord compression by paraspinal muscles after cervical laminectomy was diagnosed using flexion-extension MRI. This imaging technique identified compression not visible on standard MRI, leading to successful surgical intervention and patient improvement.
Area of Science:
- Neurosurgery
- Radiology
- Spinal Cord Imaging
Background:
- Dynamic spondylotic spinal cord compression can be identified using flexion-extension (kinematic) MRI, which is not always apparent on static MRI.
- The utility of kinematic MRI in diagnosing postoperative complications, particularly dynamic compression, is less established.
- Cervical spondylotic myelopathy can lead to functional decline and requires effective diagnostic and treatment strategies.
Purpose of the Study:
- To describe a novel case of dynamic spinal cord compression caused by paraspinal muscles following cervical laminectomy.
- To highlight the diagnostic value of flexion-extension MRI in identifying postoperative dynamic spinal cord compression.
- To present a successful surgical management strategy for this specific complication.
Main Methods:
- A 90-year-old male with cervical spondylotic myelopathy underwent multilevel laminectomy.
- Postoperatively, the patient experienced progressive weakness and worsening myelopathy.
- Standard MRIs and flexion-extension X-rays were inconclusive; kinematic MRI revealed dynamic paraspinal muscle compression during neck extension.
Main Results:
- Kinematic MRI demonstrated dynamic spinal cord compression by paraspinal muscles exclusively during neck extension.
- The patient underwent instrumented fusion with cross-links to reposition paraspinal muscles, relieving the compression.
- Neurologic improvement was observed following the corrective surgery.
Conclusions:
- This case report details a unique instance of spinal cord compression by paraspinal muscles after cervical laminectomy.
- Flexion-extension MRI is a valuable tool for diagnosing dynamic spinal cord compression in patients with persistent or delayed myelopathy after posterior decompression.
- Early and accurate diagnosis using kinematic MRI can lead to effective treatment and improved patient outcomes.
