Results of using intraoperative ultrasound in surgery of neurodegenerative disorders of the lumbar spine

Abstract

Aim. To evaluate the results of intraoperative ultrasound examination (IOUS) in surgery of degenerative diseases of the lumbar spine. Materials and methods. To evaluate the results of the use of IOUS in the surgery of degenerative diseases of the lumbar spine, an analysis of prospective examination data of 147 patients operated on for degenerative diseases of the lumbar spine in the neurosurgical department of the B.V. Petrovsky National Research Center of Surgery from 2014 to 2018. To study the accuracy of the ultrasound method for determining the level of surgical access and assessing the degree of radiation load reduction, to study the quality of ultrasound imaging of the structures of the spinal canal, a descriptive study was conducted that included 100 patients (a group of method descriptions). To determine the effectiveness of the use of IOUS, a randomized controlled trial was conducted based on a statistical comparison of the results of surgical treatment of 2 similar parallel groups of patients (control and experimental) consisting of 47 patients each, who differed only in the use of IOUS. Patients of the control group were selected from the method description group. The control and experimental groups of patients were compared according to the following criteria: the duration of surgery, the volume of intraoperative blood loss, the duration of hospitalization, the degree of root pain after surgery, the level of quality of life after surgery, the number of recurrences of herniated disc. For IOUS, we used BK Medical Pro Focus 2202 and BK Medical Flex Focus 400 ultrasound machines with neurosurgical sensors Craniotomy 8862 and Burr-Hole 8863. We performed IOUS before flavotomy, after flavotomy and after decompression of nerve structures. Results. The method of determining the level of surgical access using IOUS has a high accuracy (100 %) and allows you not to use radiography and reduce the radiation load (on average by 0.02 mSv per patient). IOUS allows to adequately visualize the structures of the spinal canal in patients with degenerative pathology of the lumbar spine: the sensitivity of the method before flavotomy is 93 %, after flavotomy – 97 %, and after decompression of nerve structures – 100 %. Due to the high sensitivity of the IOUS method, it allows optimizing surgical access, controlling the radicality of decompression of nerve structures, documenting the fact of their decompression. The use of IOUS in patients with degenerative diseases of the lumbar spine can improve the results of surgical treatment by reducing the number of recurrences of disc herniation, reducing the degree of radicular pain after surgery, reducing the duration of surgery and the volume of intraoperative blood loss. Conclusion. IOUS is a simple, harmless and widely available method of intraoperative imaging, which allows to improve the results of surgical treatment of patients with degenerative pathology of the lumbar spine.