Intraoperative spine ultrasound: application and benefits

Purpose: Intraoperative ultrasound (IUS) has been described in numerous papers as an effective tool for spinal tumor resection, degenerative lesions and Chiari malformation surgery, but has not been routinely adopted by spine surgeons. We herein describe our experience with routine IUS application. Methods: In 2011, the authors began to use Aloka Prosound Alpha 7 at the Sheba Medical Center during neurosurgical spinal tumor resection, thoracic disc herniation and Chiari malformation. In this paper, we retrospectively evaluated the volume of usage and the extent of intraoperative modification resulting from the use of IUS. Results: During 2011–2013 we identified 131 cases that IUS could be of assistance. IUS was used in 78 cases (59.5 %); 37.5 % in 2011, 65 % in 2012 and 71 % in 2013. IUS was routinely performed after exposure of the dura and repeated at surgeon’s request. As a whole, IUS changed the course of surgery in 63 % of the cases. Conclusion: IUS is safe and easy to use after a short learning curve. When used in indicated cases, it can replace cumbersome fluoroscopy, reduce the incision dimension and laminectomy levels, and demonstrate the extent of decompression. Incorporating IUS in spinal surgery education programs is warranted.