Intraoperative sonographic monitoring of reduction of thoracolumbar burst fractures

Revisiting role of Intra-operative ultrasound in Spine surgery for extradural pathologies. Review and clinical usage

OBJECTIVES

This case series looks at the role of intra-operative ultrasound in spine surgery for extradural pathologies METHODS: 10 cases of different pathologies were included. Following posterior laminectomy, intra-operative ultrasound was used to determine the adequacy of decompression. The surgical approach and the extent of surgery was then determined based on ultrasound observations. Post-operative MRI was done to correlate the ultrasound findings RESULTS: We found intra-operative ultrasound to be a very useful, easy to use and interpret tool in spine surgery. The adequacy of decompression was well visualized. The finding also corelated with the decompression achieved on a post-surgery MRI scan.

CONCLUSIONS

Intra-operative ultrasound is a useful tool in routine spine surgery. It is effective, easy to read to determine decompression for various pathologies including disc herniation, epidural abscess, tumors and deformity and reconstructive surgeries. This simple tool can help plan surgeries.

Intraoperative Ultrasound Provides Dynamic, Real-Time Evaluation of the Spinal Cord and Can Be Useful in Cases of Intraoperative Neuromonitoring Signal Changes: A Report of 3 Cases

CASES

We describe 3 pediatric spinal deformity cases that experienced neuromonitoring changes or neurologic changes in which intraoperative ultrasound allowed for evaluation of the site of cord compression to direct management. This resulted in complete neurologic recovery in all 3 patients.

CONCLUSIONS

Intraoperative ultrasound is a useful adjunct in pediatric orthopaedic spine surgery with neuromonitoring signal loss.

Use of Intraoperative Ultrasound During Spinal Surgery

STUDY DESIGN

Review and technical report.

OBJECTIVE

Intraoperative ultrasound has been used by spine surgeons since the early 1980s. Since that time, more advanced modes of intraoperative imaging and navigation have become widely available. Although the use of ultrasound during spine surgery has fallen out of favor, it remains the only true real-time imaging modality that allows surgeons to visualize soft tissue anatomy instantly and continuously while operating. It is our objective to demonstrate that for this reason, ultrasound is a useful adjunctive technique for spine surgeons, especially when approaching intradural lesions or when addressing pathology in the ventral spinal canal via a posterior approach.

METHODS

Using PubMed, the existing literature regarding the use of intraoperative ultrasound during spinal surgery was evaluated. Also, surgical case logs were reviewed to identify spinal operations during which intraoperative ultrasound was used. Illustrative cases were selected and reviewed in detail.

RESULTS

This article provides a brief review of the history of intraoperative ultrasound in spine surgery and describes certain surgical scenarios during which this technique might be useful. Several illustrative cases are provided from our own experience.

CONCLUSIONS

Surgeons should consider the use of intraoperative ultrasound when approaching intradural lesions or when addressing pathology ventral to the thecal sac via a posterior approach.

Diagnostic accuracy of ultrasound for detecting posterior ligamentous complex injuries of the thoracic and lumbar spine: A systematic review and meta-analysis

Background:

Posterior ligamentous complex injuries of the thoracolumbar (TL) spine represent a major consideration during surgical decision-making. However, X-ray and computed tomography imaging often does not identify those injuries and sometimes magnetic resonance imaging (MRI) is not available or is contraindicated.

Objective:

To determine the diagnostic accuracy of the ultrasound for detecting posterior ligamentous complex injuries in the TL spine.

Materials and Methods:

A systematic review was carried out through four international databases and proceedings of scientific meetings. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and their 95% confidence intervals (CIs) were estimated, by using weighted averages according to the sample size of each study. Summary receiver operating characteristic was also estimated.

Results:

A total of four articles were included in the meta-analysis, yielding a summary estimate: Sensitivity, 0.89 (95% CI, 0.86-0.92); specificity, 1.00 (95% CI, 0.98-1.00); positive likelihood ratio, 224.49 (95% CI, 30.43-1656.26); negative likelihood ratio, 0.11 (95% CI, 0.05-0.19); and diagnostic odds ratio, 2,268.13 (95% CI, 265.84-19,351.24). There was no statistically significant heterogeneity among results of included studies.

Summary:

Receiver operating characteristic (±standard error) was 0.928 ± 0.047.

Conclusion and Recommendation:

The present meta-analysis showed that ultrasound has a high accuracy for diagnosing posterior ligamentous complex injuries in patients with flexion distraction, compression, or burst TL fractures. On the basis of present results, ultrasound may be considered as a useful alternative when magnetic resonance imaging (MRI) is unavailable or contraindicated, or when its results are inconclusive.

Ultrasound-guided decompression of the spinal canal in traumatic stenosis

The purpose of this study was to examine the efficacy of ultrasound (US)-guided decompression of the myelon in the surgical treatment of spinal fractures. Intraoperative ultrasonography was performed in 22 patients with traumatic stenosis of the spinal canal during spinal cord surgery with removal of retropulsed bony fragments. US imaging requires a posterior approach and an enlarged foramen interarcuale. The posterior vertebral facet and the myelon can accurately be distinguished from small bony fragments by ultrasonography. Pre- and postoperative computed tomography was compared with intraoperative US imaging. Complete decompression of the spinal canal was controlled by US imaging of the restored ventral epidural space, as seen after repositioning of displaced fragments. Thus, the required extent of the surgical procedure was determined by intraoperative ultrasonography. We conclude that intraoperative US imaging is an important tool to monitor the restoration of the spinal canal and decompression of the spinal cord in case of fracture. The repositioning of stenosing bony fragments using surgical instruments can be monitored. US imaging as a real-time method intraoperatively provides the surgeon with additional information and significantly influences treatment options.

Ultrasound guided reduction of pediatric forearm fractures in the ED

Reducing badly displaced or angulated pediatric forearm fractures in the emergency department can be difficult. Multiple attempts at reduction may be required, with repeated trips to the radiology department, before an adequate reduction is achieved. We have recently found that bedside ultrasound by emergency physicians is very helpful in guiding the reduction of difficult forearm fractures, allowing the physician to assess the adequacy of the reduction at the patient's bedside. In this report, we describe the technique we have developed for ultrasound-guided fracture reduction and present three case histories showing the usefulness of this technique.