Systematic Review: Applications of Intraoperative Ultrasonography in Spinal Surgery

Background: As a result of increased practicality and decreased costs and radiation, interest has increased in intraoperative ultrasonography (iUS) in spinal surgery applications; however, few studies have provided a robust overview of its use in spinal surgery. We synthesize findings of existing literature on use of iUS in navigation, pedicle screw placement, and identification of anatomy during spinal interventions.

Methods: PRISMA guidelines were used in this systematic review. Studies were identified through PubMed, Scopus, and Google Scholar databases using the search string. Abstracts mentioning iUS in spine applications were included. On full-text review, exclusion criteria were implemented, including outdated studies or those with weak topic relevance or statistical power. On elimination of duplicates, multireviewer screening for eligibility, and citation search, 44 articles were analyzed.

Results: Navigation using iUS is safe, effective, and economical. iUS registration accuracy and success are within clinically acceptable limits for image-guided navigation. Pedicle screw instrumentation with iUS is precise, with a favorable safety profile. Anatomic landmarks are reliably identified with iUS, and surgeons are overwhelmingly successful in neural or vascular tissue identification with iUS modalities, including standard B mode, Doppler, and contrast-enhanced ultrasonography. iUS use in traumatic reduction of fractures properly identifies anatomic structures, intervertebral disc space, and vasculature.

Conclusions: iUS eliminates radiation, decreases costs, and provides sufficient accuracy and reliability in identification of anatomic and neurovascular structures in various spinal surgery settings.