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Intraoperative Ultrasound of the Spine 2013

Category General Spine Alexander Brian. Schabel
Lubdha Shah, MD
Purpose To demonstrate the utility of intraoperative ultrasound during spine surgery. Materials & Methods A Siemens S2000 with either an 18 MHz or 14 MHz linear transducer was utilized to image the spinal cord and intrathecal contents prior to opening the dura in 8 cases (7 tumors, 1 radiculomedullary pseudoaneurysm).  The surgical field was filled with sterile saline and the transducer was suspended in the saline bath above the dura while images were obtained.  Gray-scale, pulsed wave, and color Doppler imaging were routinely performed. Results Intraoperative ultrasound was primarily utilized to evaluate the extent of intradural tumors and aid in determining extension of the laminectomies. This real-time imaging technique affected surgical approach in most cases.  Preliminary attempts were additionally made to assess for cerebrospinal fluid flow within cystic areas near tumors to help differentiate syrinx from cystic tumor components and to characterize pulsed Doppler waveforms in different types of spinal tumors.  In the solitary pseudoaneurym case, an attempt was made to identify the aneurysm prior to opening the dura. This successfully showed lack of flow within the pseudoaneurysm as it had already spontaneously thrombosed. Conclusion Intraoperative ultrasound with a modern high frequency probe is a useful and flexible problem-solving tool during spine surgery, specifically spinal tumor resection. References Zhou H, Miller D, Schulte DM, Benes L, Bozinov O, Sure U, Bertalanffy H. Intraoperative ultrasound assistance in treatment of intradural spinal tumours. Clin Neurol Neurosurg. 2011 Sep;113(7):531-7. Epub 2011 Apr 20. PubMed PMID: 21507563.