Use of Intraoperative Ultrasound During Spinal Surgery

Abstract

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.

Keywords: intramedullary tumor; intraoperative ultrasound; spine surgery; thoracic disc herniation; thoracolumbar burst fracture.

Figure 1.

(A) Sagittal T2-weighted MRI reveals lesion centered at C5-7, with an associated fluid collection at the most rostral part of the lesion. (B) Sagittal T1-weighted MRI of lesion. (C) Sagittal contrast-enhanced MRI reveals scant rim enhancement. (D) Axial T2-weighted MRI centered on the fluid collection. (E) Axial T2-weighted MRI at more caudal part of the lesion.

Figure 2.

Intraoperative ultrasound of spinal cord after laminectomy reveals lesion. (A) Fluid collection can be seen at the left (white arrow). (B) Looking at axial perspective, one can see lesion encompassing most of the spinal cord. (C) Using a piece of Gelfoam (white arrow), one is able to make sure that most caudal aspect of lesion is exposed during intramedullary dissection. (D) Ultrasound after resection of lesion reveals resolution of mass effect.

Figure 3.

(A) Sagittal T2-weighted MRI taken 2 months postoperatively reveals complete resection of tumor. (B) T1-weighted MRI without contrast and (C) contrast-enhanced reveals complete resection.

Figure 4.

(A) Sagittal and (B) axial T2-weighted MRI images demonstrating a large T10-11 disc herniation resulting in severe spinal cord compression.

Figure 5.

Longitudinal intraoperative ultrasound images demonstrating (A) a large disc herniation displacing the spinal cord and thecal sac and (B) complete spinal cord decompression at the conclusion of surgery.

Figure 6.

(A) Sagittal and (B) axial CT demonstrating a pathological L2 burst fracture.

Figure 7.

Longitudinal intraoperative ultrasound images demonstrating (A) a retropulsed bone fragment in the ventral spinal canal deforming the thecal sac at the level of the conus medullaris and (B) complete reduction and decompression of the spinal canal. The right side of the image is cranial and the left side is caudal.