Introduction: Preclinical and clinical evidence support spinal cord decompression as a surgical treatment of spinal cord injury. Prior studies describe the time to surgery as a variable of interest, yet adequate surgical decompression is rarely verified via imaging. We utilized postoperative MRI to analyze the rate of complete spinal cord decompression following decompression and internal fixation of subaxial cervical spine blunt injuries.

Methods: Preoperative (within 8 hours of injury) and postoperative (within 48 hours of injury) MRI images of 184 motor complete (AIS grade A=119, AIS grade B=65) patients were independently reviewed by 3 neurosurgeons to verify spinal cord decompression. Decompression was defined as the presence of a patent subarachnoid space around a swollen spinal cord.

Results: Ninety-eight of 184 (53%) patients underwent anterior cervical discectomy and fusion (ACDF), 51 of whom also underwent laminectomy. Fifty-seven (31%) patients underwent anterior cervical corpectomy and fusion (ACCF) with (28 patients) or without (29 patients) laminectomy. Twenty-nine (16%) patients underwent laminectomy without a concomitant anterior procedure. The rate of complete decompression in patients who underwent ACDF or ACCF without laminectomy was 46.8 and 58.6%, respectively. Laminectomy significantly increased the rate of successful decompression (70.6% and 75% of patients, respectively). Conversely, 25 of 29 (86.2%) patients who underwent laminectomy without a concomitant anterior procedure were successfully decompressed. The rate of decompression among patients who underwent laminectomy at 1, 2, 3, 4, or 5 levels was 58.3%, 68%, 78%, 80%, and 100% respectively (p<0.001). Longer pre (47.7 mm) and post-operative (71 mm) intramedullary lesion length had a negative impact on decompression (p<0.0001). In multivariate logistic regression analysis only laminectomy was significantly associated with successful decompression (OR 4.85 95%CI 2.2-10.6 p<0.001).

Conclusions: In motor-complete spinal cord injury patients, laminectomy significantly increases the rate of successful spinal cord decompression, independent of whether anterior surgery is performed.

Patient Care: Spinal cord decompression following trauma is gaining more traction. We tried to alert surgeons that different surgical techniques may not offer equal opportunity for spinal cord decompression.

Learning Objectives: 1-To differentiate between surgical technique and spinal cord decompression in subaxial cervical spinal cord injury. 2-To Clarify the relationship between spinal cord swelling and spinal cord decompression. 3-To express the capabilities of specific surgical techniques and spinal cord decompression following trauma.

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