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Intra-osseous ultrasound for pedicle screw positioning in the subaxial cervical spine: an experimental study.

Abstract：

BACKGROUND:In contrast to other regions of the human spine, dorsal fixation with rods and pedicle screws is comparatively rarely performed in the cervical spine. Although this technique provides a higher mechanical strength than the more frequently used lateral mass screws, many surgeons fear the relatively high rate of misplacements. This higher incidence is mainly due to the complex vertebral anatomy in this spinal segment. For correct screw placement, the availability of an immediate and efficient intra-operative imaging tool to ascertain the accuracy of the pedicle screw hole position would be beneficial. We have previously investigated the usefulness of an intraspinal, specifically, intra-osseous ultrasound technique in the lumbar spine. In this study its accuracy as a means of controlling intrapedicular screw hole positioning has been evaluated in the cervical spine. METHODS:An endovascular ultrasound transducer was used for the intra-luminal scanning of 54 pedicle screw holes in cadaveric human spine specimens. Twenty-three of these had been intentionally misplaced (cortex breached). The resulting image files were assessed by three investigators blinded to both the procedure and the corresponding CT findings. FINDINGS:The investigators differentiated correctly between adequately and poorly placed pedicle screw holes in 96% of cases. False negatives and false positives both occurred in no more than 1.8% of cases. CONCLUSIONS:Intrapedicular ultrasonography of pedicle screw holes in the cervical spine is a promising technique for the intra-operative assessment of bore hole placement and may increase operative safety and postoperative outcome in posterior cervical fusion surgery.

journal_name

Acta Neurochir (Wien)

journal_title

Acta neurochirurgica

authors

Kantelhardt SR,Bock HC,Siam L,Larsen J,Burger R,Schillinger W,Bockermann V,Rohde V,Giese A

doi

10.1007/s00701-009-0447-6

subject

Has Abstract

pub_date

2010-04-01 00:00:00

pages

655-61

issue

4

eissn

0001-6268

issn

0942-0940

journal_volume

152

pub_type

杂志文章

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