Yun Dong, XiongXiong Zuo, HaiTao Sun, He Wang, ShaoHui He, JianRu Xiao, XiaoPan Cai
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Abstract
Purpose
Experimental assessment of the efficiency of intraosseous ultrasound (IOUS) utilizing the mini probe of endoscopic ultrasound (EUS) is performed to determine the accuracy of pedicle screw hole placements in thoracolumbar spine.
Methods
Drill holes in 76 pedicles of thoracolumbar spines from 2 cases of goats. Each pedicle screw hole is subjected to a 360° circumferential IOUS scanning with a catheter-type mini ultrasound probe of EUS and to a CT examination. Subsequently, all ultrasound images were independently interpreted by 3 reviewers without knowledge of the real position of screw holes and the results of the CT examination for the assessment of screw hole malposition and pedicle cortex breach. Finally, according to the conclusion of CT, a Chi-square test is employed to assess the differences of interpretations of the screw hole malposition among the all reviewers and the relevant relationship between the recognition of the misplaced screw holes and imaging methods utilized.
Results
CT revealed 13 correctly positioned holes and 63 holes deviating from correct position (including holes that penetrated the cortex). All ultrasound images with malposition identified by CT were correctly interpreted, with no false negatives and no intra-reviewer differences. There were no omissions of severe malposition (including the spinal canal was penetrated into). Excluding six false positives misjudged due to the intersection of screw holes on both sides, there was also no discrepancy between the EUS and CT imaging in the interpretation of screw hole malposition. The examination time of each pedicle screw hole with EUS took less than 15 s.
Conclusion
EUS-based IOUS is an immediate, reliable and lower-cost technique for accurate determination of pedicle screw hole malposition. With a probe that is both flexible and not easily bendable, the EUS is particularly suitable for IOUS, especially in the narrow space of the bone gaps or bone canals, and minimally invasive spine surgery (MISS).
期刊介绍：
The journal "Acta Neurochirurgica" publishes only original papers useful both to research and clinical work. Papers should deal with clinical neurosurgery - diagnosis and diagnostic techniques, operative surgery and results, postoperative treatment - or with research work in neuroscience if the underlying questions or the results are of neurosurgical interest. Reports on congresses are given in brief accounts. As official organ of the European Association of Neurosurgical Societies the journal publishes all announcements of the E.A.N.S. and reports on the activities of its member societies. Only contributions written in English will be accepted.
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