Impact of Intra-operative Ultrasound on Decision Making During Spinal Surgery: A Case Series

Introduction: Despite the increased use of navigation and robotic assistance in spine surgery, there continues to be a lack of intra-operative dynamic imaging feedback to aid surgical decision making. Traditional imaging methods such as computed tomography and magnetic resonance imaging are essential in preoperative planning and postoperative assessment but are too unwieldy, expensive or time consuming to use in real-time during surgery. We outline the role of ultrasound in spine surgery, and its utility in guiding decisions intra-operatively.

Methods: We reviewed 10 cases during which the ultrasound was used. The cases included a variety of intradural and extradural pathology: 4 cervical, 5 thoracic, and 1 lumbar. We summarized the reasons for using ultrasound in each case as well as influence on intraoperative decision making. We also summarized relevant ultrasound anatomy using intra-operative photos and videos.

Results: We found that intra-operative ultrasound is valuable in understanding relational anatomy, identifying relevant vascular structures, confirming removal of ventral pathology, ensuring appropriate detethering from arachnoid webs or adequate reduction during spinal cord herniation, and as an additional method to confirm pathologic level. Intra-operative decisions during the reviewed cases were frequently influenced by information gained from ultrasound.

Conclusion : Intra-operative ultrasound during spine surgery has numerous applications both as an adjunct to existing imaging methods and as a novel tool to gain dynamic intra-operative feedback. Further work is needed to describe the use of ultrasound in spine surgery and to evaluate its potential role as part of standard practice in specific cases.