On High Frequency Ultrasound Imaging For Guided Screw Insertion In Spinal Fusion Surgery

Thursday, June 1, 2023

8:30 AM – 6:15 PM

Location: Salons 7-8

Presenting Author (Person doing the Podium Present(s)

SL

Suoyuan Li

attending doctor
Department of Orthopeadic Surgery, the Affiliated Suzhou Hospital of Nanjing Medical University
Suzhou, Jiangsu, China (People's Republic)

View E-Poster

Co-Author(s)

YX

Yiwen Xu

China (People's Republic)
WS

Weiwei Shao

China (People's Republic)
YC

Yaoyao Cui

China (People's Republic)
DW

Donglai Wang

China (People's Republic)
JS

Jun Shen

China (People's Republic)

Submitter(s)

SL

Suoyuan Li

attending doctor
Department of Orthopeadic Surgery, the Affiliated Suzhou Hospital of Nanjing Medical University
Suzhou, Jiangsu, China (People's Republic)

View E-Poster

Disclosure(s):

Suoyuan Li, N/A: No financial relationships to disclose

Introduction: Spinal fusion surgery usually involves the insertion of screws in the pedicle, and high skill is required during the implantation of screws to avoid causing peri - pedicle vascular nerve injury.
Aims/

Objectives: This paper presents an image guidance technique based on the generation of B-mode images from within small holes of the trabecular bone of the pedicles. The aim was to determine the feasibility and safety of hole placement for subsequent screw insertion.
Methods; Pedicle screw holes were placed in 72 pedicles of 3 porcine cadaver lumbar spine specimens. 31 optimal trajectories were placed and 41 intentional cortical breaches. Each pedicular drill hole was examined using a 360°high-frequency (30MHz) ultrasonic microtransducer and CT scanning. The ultrasonographic images were reviewed by 3 independent investigators who were blinded to the CT findings. In addition, 12 screw holes were placed intraoperatively in one patient, and equally assessed by intraoperative intraosseous ultrasonography and postoperative CT scanning.

Results: Three - dimensional Ultrasonographic images of pedicle screw holes in orcine cadaver lumbar spine specimens were correctly interpreted in 97.6% of cases. Only one cortical breach was missed, i.e., no false-negatives occurred. Only one breach was not detected by the ultrasonic device but showing on CT scanning (false negative).

Conclusions: Our homemade intraosseous ultrasound detector is a highly reliable technique for intraoperative evaluation of the pedicle screw hole prior to pedicle screw placement. It has great application value because of its real - time and three - dimensional image in bore hole.