Intraoperative Ultrafast Ultrasound Doppler Imaging of Degenerative Cervical Myelopathy Helps Predict Neurological Recovery.

OBJECTIVES

The mechanism of neurological recovery after surgical decompression is still unclear for degenerative cervical myelopathy (DCM). This study aims to analyze the relationship between microvasculature in the post-decompressed spinal cord segments and neurological recovery and further design a prediction model of recovery.

METHODS

This prospective cohort study analyzed data from a cohort of patients with DCM who underwent surgical decompression from May 2023 to May 2024 at a single center. Intraoperative ultrasound ultrafast Doppler imaging was performed to evaluate the microvasculature of post-decompressed spinal cord segments. Differences in 5 microvascular indexes between post-decompressed spinal cord segments and normal spinal cord segments were calculated for each participant. All participants were followed up for 1 year to obtain modified Japanese Orthopedic Association (mJOA) scores. Participants were divided into favorable and unfavorable recovery groups based on a threshold of 50% for the recovery rate of mJOA scores. The Mann-Whitney U test compared microvascular indexes between the 2 groups. Kolmogorov-Arnold Network was further introduced to predict neurological recovery based on the proposed microvascular indexes.

RESULTS

Forty-eight participants (median age, 59 years [IQR, 54-66 years]; 36 males) were included. Thirty-seven participants had a favorable recovery. All 5 microvascular indexes were associated with neurological recovery (all p < .05). The proposed prediction model achieves an accuracy of 94% (45 of 48) and an area under the receiver operating characteristic curve (AUC) of 0.98 (95% CI: 0.90, 1.00).

CONCLUSIONS

Microvasculature of post-decompressed spinal cord segments is associated with neurological recovery and can effectively predict neurological recovery.