Influence of acute shortening on the spinal cord: an experimental study.

Study Design: Morphometric changes of the spinal cord and influence on spinal cord-evoked potentials and spinal cord blood flow and postoperative function of hind limbs were studied in various degrees of acute spinal column shortening in dogs.

Objectives: To study the morphometric and physiologic effects of acute spinal column shortening on the spinal cord.

Summary Of Background Data: The technique of acute spinal column shortening is sometimes applied for correction of spinal deformity, total en bloc spondylectomy operation, or other diseases. However, safe limits and physiologic effects of acute spinal column shortening have not yet been described.

Methods: Total spondylectomy of T13 was performed in dogs after spinal instrumentation placed 2 levels above and 2 levels below the spondylectomy level. Spinal column was gradually shortened until the lower endplate of T12 contacted the L1 upper endplate (maximum of 20 mm). When any morphologic change of the dural sac or the spinal cord was observed, the length of shortening was measured. Spinal cord-evoked potentials were recorded on the exposed dura mater following epidural stimulation at the C7 level in 8 dogs. Spinal cord blood flow was measured during shortening in 6 dogs. Hindlimb function was evaluated 2 weeks after operation in 10 dogs.

Results: No morphometric changes occurred in the dural sac and the spinal cord until shortening of 7.2 +/- 1.7 mm (n = 6). From 7.2 +/- 1.7 to 12.5 +/- 1.1 mm shortening, the dural sac was deformed, whereas the spinal cord maintained its shape. Shortening more than 12.5 +/- 1.1 mm buckled the dural sac, and the spinal cord kinked itself and was compressed by the buckled dura in its concave side (n = 6). No changes could be detected in spinal cord-evoked potentials in 5 or 10 mm of shortening. Spinal cord-evoked potential changes were recorded in the 2 of 6 dogs with 15 mm of shortening. At 20 mm of shortening, spinal cord-evoked potential abnormality was observed in 4 of 6 dogs. At shortening of 5, 10, 15, and 20 mm, spinal cord blood flow was 146 +/- 10%, 160 +/- 21%, 102 +/- 17%, and 93 +/- 7% of the control (29.2 +/- 7.9 mL/100 g/min, n = 6), respectively. All 3 dogs with 10 mm ofshortening had normal hindlimb function 2 weeks after operation. One of the 3 dogs with 15 mm of shortening had paraparesis. Three of the 4 dogs with 20 mm of shortening had also paraparesis after operation.

Conclusions: Acute spinal column shortening can be characterized into 3 phases. Phase 1, safe range: occurred during shortening within one-third of the vertebral segment and is characterized by no deformity of the dural sac or the spinal cord. Phase 2, warning range: occurred during spinal shortening between one-third and two-thirds of the vertebral segment and is characterized by shrinking and buckling of the dural sac and no deformity of the spinal cord. Phase 3, dangerous range: occurred after shortening in excess of two-thirds of the vertebral segment and is characterized by spinal cord deformity and compression by the buckled dura. Spinal shortening within the safe range increases spinal cord blood flow.