Use of Intraoperative Ultrasound During Spinal Surgery

Vasudeva, Viren S.; Abd-El-Barr, Muhammad M.; Pompeu, Y.A.; Karhade, Aditya V.; Groff, Michael W.; Lu, Yi

doi:10.1177/2192568217700100

Cited by 37 publications

(22 citation statements)

References 55 publications

(95 reference statements)

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“…Hence, image guidance such as navigation system or intra-operative ultra sound could be considered the most reliable methods to visualize the ventral epidural space and assess restoring of the ventral CSF space as reported by Vasudeva et al and Kelly at al. [22] , [107] , [108] .…”

Section: Evolution In Surgerymentioning

confidence: 99%

Separation surgery for metastatic epidural spinal cord compression: A qualitative review

Perna

Cofano

Mantovani

et al. 2020

Journal of Bone Oncology

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Highlights Separation surgery is a new concept for metastatic spinal cord compression treatment. Stereotactic radiosurgery increased local control, overcoming radio-resistance’s idea. The surgery goal shifted towards creating targets for radiations avoiding cord damages. Minimal invasive strategies could allow quick return to systemic therapies.

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Section: Evolution In Surgerymentioning

confidence: 99%

Separation surgery for metastatic epidural spinal cord compression: A qualitative review

Perna

Cofano

Mantovani

et al. 2020

Journal of Bone Oncology

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“…A spinal cord surgery, is known as a sensitive and delicate one, with a high risk of post-surgical adverse effects [6][7][8]. These surgeries are planned, using data from images of a pre-operative Computer Tomography Image's (CTI) and/or Magnetic Resonance Image's (MRI) [9,10] and also from a Planar X-ray Image (PXI) (performed at the beginning of the surgery, when the patient is already anesthetized and in the 'surgical position').…”

Section: Introductionmentioning

confidence: 99%

“…A preliminary study using US was reported on newborns [7,8], for in-vitro studies, where a complete tumor resection was reported [16]. It was also applied during laminoplasty, as it is a useful method for evaluating spinal cord decompression status [12].…”

Section: Introductionmentioning

confidence: 99%

Intraoperative Spinal Cord Remote Monitoring with a Modified US A-Scope

Zaaroor¹,

Sviri²,

Sinai³

et al. 2021

austinjclincaserep

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Materials and Methods: The motivation for this feasibility study were: (i) to modify the ultrasonic A-scope in order to monitor remotely, intraoperatively and in real-time tumor’s depth and size, before cutting its dura and to control tumor’s residual thickness while its resection and (ii) to demonstrate these abilities during several spinal-cord surgeries. Results: The ultrasonic A-scope was modified for these purposes, to a noncontact, intraoperative and real-time device. It was successfully applied during several human spinal cord clinical trials. Its data were compared with those of a pre-operative MRI (of the same person), where a good similarity was obtained between them, with a difference less than 1mm, in most cases. Conclusions: The modified A-Scope advantages: (i) remote, intraoperative and real-time monitoring; (ii) accurate and objective data was obtained; (iii) there is no direct contact between the US transducer and the monitored tissue, as the ultrasound propagates through a free stream of normal saline; (iv) the length of the free stream is few mm, at least; (v) the handpiece enables to monitor in a confined area, as it has a small foot-print; (vi) it is simple to operate the device; (vii) it enables to define intraoperatively tumor edges, before cutting and opening the dura. Consequently, this modified device seems to be a valuable and useful tool to define intraoperatively tumor’s location and its complete removal and reducing potential damages to healthy tissues surrounding it.

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“…18 , 21 , 22 Advances have occurred in many aspects of ultrasound technology including sensors, computer hardware, and software. It is used in spinal applications, 23 , 24 and has even been used in the cervical spine in outer space. 25 , 26 …”

mentioning

confidence: 99%

“…A recent review summarized the use of ultrasound in spinal diagnostic and therapeutic applications 27 and another reviewed the use of ultrasound in spine surgery, 24 claiming the use of intraoperative ultrasound was mainly for tumors or calcified thoracic discs. A more recent study reported the clinical evaluation of ultrasound for lateral lumbar spine surgery.…”

mentioning

confidence: 99%

Artificial Intelligence-enabled, Real-time Intraoperative Ultrasound Imaging of Neural Structures Within the Psoas

Carson

Ghoshal

Cornwall

et al. 2020

Spine

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Study Design. Experimental in-vivo animal study. Objective. The aim of this study was to evaluate an Artificial Intelligence (AI)-enabled ultrasound imaging system's ability to detect, segment, classify, and display neural and other structures during trans-psoas spine surgery. Summary of Background Data. Current methodologies for intraoperatively localizing and visualizing neural structures within the psoas are limited and can impact the safety of lateral lumbar interbody fusion (LLIF). Ultrasound technology, enhanced with AI-derived neural detection algorithms, could prove useful for this task. Methods. The study was conducted using an in vivo porcine model (50 subjects). Image processing and machine learning algorithms were developed to detect neural and other anatomic structures within and adjacent to the psoas muscle while using an ultrasound imaging system during lateral lumbar spine surgery (SonoVision,™ Tissue Differentiation Intelligence, USA). The imaging system's ability to detect and classify the anatomic structures was assessed with subsequent tissue dissection. Dice coefficients were calculated to quantify the performance of the image segmentation. Results. The AI-trained ultrasound system detected, segmented, classified, and displayed nerve, psoas muscle, and vertebral body surface with high sensitivity and specificity. The mean Dice coefficient score for each tissue type was >80%, indicating that the detected region and ground truth were >80% similar to each other. The mean specificity of nerve detection was 92%; for bone and muscle, it was >95%. The accuracy of nerve detection was >95%. Conclusion. This study demonstrates that a combination of AI-derived image processing and machine learning algorithms can be developed to enable real-time ultrasonic detection, segmentation, classification, and display of critical anatomic structures, including neural tissue, during spine surgery. AI-enhanced ultrasound imaging can provide a visual map of important anatomy in and adjacent to the psoas, thereby providing the surgeon with critical information intended to increase the safety of LLIF surgery. Level of Evidence: N/A

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Use of Intraoperative Ultrasound During Spinal Surgery

Cited by 37 publications

References 55 publications

Separation surgery for metastatic epidural spinal cord compression: A qualitative review

Separation surgery for metastatic epidural spinal cord compression: A qualitative review

Intraoperative Spinal Cord Remote Monitoring with a Modified US A-Scope

Artificial Intelligence-enabled, Real-time Intraoperative Ultrasound Imaging of Neural Structures Within the Psoas

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