Intraoperative Myelography in Cervical Multilevel Stenosis Using 3D Rotational Fluoroscopy: Assessment of Feasibility and Image Quality

Table 1

Characteristics and surgical approach in patients undergoing intraoperative myelography. One of the patients had upper thoracic stenosis due to osteomyelitic vertebral body fracture. Myelography was performed to evaluate if the extent of decompression was sufficient. Image quality largely depends on metal artifacts and if the thoracic kyphosis can be overcome (OPLL = ossification of the posterior longitudinal ligament, VA = vertebral artery, CSM = cervical spondylotic myelopathy, f = female, m = male, CT = computed tomography, MRI = magnetic resonance imaging, and EMS = European Myelopathy Score).

Patient number	Name, sex, age	Pathology	Approach	Procedure	Image quality	Change of operative strategy	Residual stenosis in; postoperative imaging	Clinical result; (EMS before/after surgery
1	D.N., m, 76 y	OPLL; (after corpectomy C4–6)	Posterior	Spondylodesis C3–C7	+	Additional laminectomy C4	No (MRI)	12/14
2	K.S., m, 70 y	OPLL	Posterior	Laminectomy C1–C3; Spondylodesis C1–C3	(+)	—	No (MRI)	16/18
3	G.P., f, 69 y	Osteomyelitic fracture; T3 and T4	Posterior	Costotransversectomy and; vertebrectomy T3 and T4; ventrodorsal spondylodesis	− (metal artifacts)	—	No (MRI)	6/died 6 weeks after surgery; due to peritonitis
4	E.M., f, 76 y	CSM, increasing dislocation of; C2 fracture 3 months earlier	Posterior	Laminectomy C3–C5; Spondylodesis C2–C6	(+)	—	No (MRI)	17/18
5	W.S., f, 68 y	CSM, aggravated after laminectomy C5	Anterior	Corpectomy C4/5	−	—	No (MRI)	7/12
5	W.S., f, 68 y	CSM, aggravated after laminectomy C5; VA injury during corpectomy	Posterior	Laminectomy C4–C7; Spondylodesis C2–T2	+	Extension of posterior decompression	No (MRI)	7/12
6	E.N., m, 70 y	CSM, discectomy C4/5 1 year earlier	Anterior	Corpectomy C5	+	—	No (MRI)	15/16
7	W.S., m, 62 y	Dislocated C1/2 fracture	Posterior	Spondylodesis C1–3	+	—	No (CT)	17/18
8	R.M., m, 74 y	CSM	Posterior	Laminectomy C3 and C4; Spondylodesis C2–C6	+	Extension of decompression	No (MRI)	13/13
9	M.K., f, 73 y	CSM	Anterior	Discectomy C4/5 and 5/6	+	2-level discectomy instead of corpectomy	No (CT)	11/13