Intraoperative ultrasonography in thoracolumbar fractures with intraspinal bone fragments. Evaluation of canalar stenosis and anatomic check of decompression: comparative study with the CT-scan

Abstract

Intraoperative ultrasonography is recommended for operations on the thoracolumbar spine to complement the information provided by standard X-ray, intensifier screen or myelography. There are no unanimates opinions concerning the impaction or exeresis of these fragments. The aim of this study was to show the advantages of intraoperative ultrasonography for anatomic determination and control of the maneuvers used. This study included 46 cases with fractures from T11 to L2. Ultrasonography was performed during the intraoperative reduction provided by the installation and the pedicular instruments. The authors stress the limits of the anatomic and geographic determination, as well as tilting of the fragments because of the size of the ultrasonographic head. The quality of the exeresis may be falsely interpreted in the presence of fragments with a section of less than 4 mm, lateralized, double fragments or in the presence of massive intraoperative haemorrhage. Analysis of the impaction results is more complicated because all of these fragments displaced themselves secondarily. The ligamentum communis vertebralis posterior has no anatomical containing role. The tilting before the impaction and the state of the overlying intervertebral disk represent essential factors for failures. Ultrasonography is better than intraoperative myelography. Nevertheless, it still needs to be complemented by intraoperative profile X-rays and a very precise preoperative CT scan of the intervertebral disk lesions analysis of complicated cases (fragments with residual pedicular attachments--type A 3.1.2.; T-like fractures--type A 3.2.1.).

Herniated intervertebral disc associated with a lumbar spine dislocation as a cause of Cauda Equina syndrome: a case report

“…During surgical reduction, it is advisable to explore the lumbar canal throughout the procedure to insure the lack of dural compression by disc or bony fragments in the end of surgery. Some authors proposed [3,6,9] intra-operative ultrasound guidance to evaluate reduction of spinal fractures and to monitor repositioning of the narrowing fragments during the posterior approach. They concluded that intra- operative ultrasonography is a safe and accurate method, easy to repeat and avoids the disadvantages and pitfalls of intra-operative myelography [3,10].…”

The utility of ultrasound for surgical spinal decompression

“…However, in a study performed on 46 cases, the authors concluded that intra-operative US is superior to myelography in patients with thoracolumbar spine fractures. Yet, they underscored the need to complement US with intraoperative X-rays and highly precise pre-operative CT scanning [34]. …”