Literature on spine ultrasound has grown over the last 22 years. Increased interest has led to updates in the technology used to evaluate spinal and paraspinal regions.
Look at the available evidence with Hospital Procedures Consultants.
Latest Updates in Spine Ultrasound
Updates in ultrasound of the spine go beyond improved image quality and motion tracking. They include developments in the techniques used to investigate the bone column.
Latest trends include but aren’t limited to:
1. Pre-procedural Spine Ultrasound for Difficult Lumbar Punctures
It is helpful for charting the trajectory while utilizing fewer needle passes and creating fewer punctures on the skin. A 2021 meta-analysis supports its benefits, it showed that the overall risk of technical failure among obese and difficult spinal patients is superior to the landmark-guided lumbar puncture technique. A systematic review and meta-analysis of 14 trials in over 1,300 adults demonstrated a lower failure rate (1% vs 7.2%), a reduced risk of traumatic LPs (RR = 0.27), fewer insertion attempts (0.5 fewer attempts) and a decreased number of needle redirections (1 less needle redirections) with ultrasound-directed lumbar punctures vs landmark-guided lumbar punctures.
Similar results were seen for ultrasound-directed lumbar punctures in infants which demonstrated a success rate of 82% with landmark-guided lumbar punctures vs a 100% success rate with ultrasound-directed lumbar punctures (OR = 9.33 in favor of ultrasound-directed LPs). The first puncture success rate was also higher with ultrasound-directed lumbar punctures vs landmark-guided lumbar punctures (RR = 1.41).
2. Focused Ultrasound for Spinal Cord Injury
With 250,000 to 500,000 patients worldwide suffering from a spinal cord injury each year, low-intensity focused ultrasound could be an innovative application as it can trigger transient physiological changes in neurons without detectable histological alterations and cellular stimulation. However, there have been no clinical studies yet on its safety and efficacy in humans, so its potential remains unclear.
Intraoperative Spine Ultrasound
Intraoperative spine ultrasound (IoUS) is the most effective real-time imaging method and the focus of our review. While its use was widely reported in the 1980s, its applications during surgeries only came later with advancements in biomedical engineering, imaging, electronics, and nanotechnology.
Applications
Intraoperative ultrasound (IUS) is an effective tool for:
Cervical Spine Disorders
A cervical spine ultrasound can help healthcare professionals perform procedures with precision and clinical efficacy.
However, ultrasonographic scanning of cervical structures can be difficult. They may not sufficiently detect cervical mucosa and lymph nodes (both normal and lymphomatous cervical). This is true even with CT (computed tomography). Hence, a comprehensive understanding of cervical sonoanatomy is a prerequisite.
Chiari Malformation Surgery
Chiari Malformation is a condition in which the lower part of the brain presses on and extends to the cerebellum into the spinal canal. This “little brain” is responsible for coordinating movement and balance. Since it’s located where the spinal cord connects to the brain, surgical intervention may be necessary to prevent further damage to the central nervous system (CNS) and to improve and stabilize symptoms.
Examination of the Neonatal Spine
Neonatal spine ultrasound could serve the same purpose as an MRI (magnetic resonance imaging) within the first three months of life for the following clinical indications:
- Atypical sacral dimple
- Haemangioma
- Hair tuff
- Palpable subcutaneous sacral mass
- Sinus tract
- Skin pigmentation
- Skin tag
Its application extends to neonates with congenital irregularities like cloacal exstrophy (a condition where internal organs in the lower abdomen are exposed) and anorectal atresia which involves the anus or a section of the rectum.
Ultrasound neonatal spine may not be the preferred choice for infants with spina bifida aperta, post-spinal surgery, and cerebrospinal fluid (CSF) with excreting lesions. These conditions come with high risks of infection, which can lead to severe complications.
Spinal Tumor Resection
IUS is used to determine the extent of the dural opening—a thick layer of connective tissue that covers the brain and spinal cord, and myelotomy. As such, it can effectively make spinal surgery on intramedullary tumors less invasive.
Thoracic Disc Herniation
Intraoperative ultrasound offers real-time visualization during transpedicular thoracic discectomy for spinal cord decompression and disc removal while enabling the surgeon to avoid cord manipulation. This makes it a valuable tool for spine surgeons, especially when treating patients with existing pulmonary diseases and those deemed medically unfit for the transthoracic approach.
Benefits
According to a 2017 review, intraoperative ultrasound during spinal surgery features several advantages over newer technologies when used appropriately.
The procedure offers the following advantages:
- It improves the safety of the surgery.
- It reduces the incision dimension, helping avoid injury to other structures.
- It is reliable for identifying anatomic and neurovascular structures.
- It has high diagnostic accuracy and has been found to change the course of surgery in 63% of cases.
In addition, it eliminates procedures that employ ionizing radiation, which have been associated with eventual harm (sometimes manifesting as cancer).
Spine Ultrasound Contraindications
Contraindications for ultrasound of spine in adults vary based on the modality employed, but the consensus remains the same: it should not be used for patients with the following conditions due to the possible effects of ultrasound therapy on spine.
- Spinal infections. An emergent MRI of the spine may be more suited as it has a reported sensitivity of 96%, a specificity of 93%, and an accuracy of 94%.
- Bone fracture could cause low-intensity pulsed ultrasound to accelerate traumatic vertebral fracture healing.
Having said that, it’s always best to consult the latest literature to determine whether advances in technology might have opened up previously unexplored avenues.
For example, ultrasound hasn’t been a standard diagnostic practice for pregnant women. But it’s now considered safe and is widely employed even in matters concerning the spine. In fact, a spinal ultrasound has been found to lessen erroneous evaluations of the L3-L4 space among pregnant women whether or not they’re obese.
Brush Up on Your Knowledge of Spine Ultrasound With Hospital Procedures Consultants
Hospital Procedures Consultants provides quality, comprehensive, evidence-based procedural education to healthcare providers. We offer a Spine Ultrasound Course that teaches participants how to identify the spine with ultrasound. Enroll to improve your skill set, deliver the best patient care, and advance in your career.
Resources:
Zhai, X. Cui, J. Shao, J. Wang, Q. Chen, X. Wei, X. Zhou, X. Chen, Z. Bai, Y. Li, M. Global research trends in spinal ultrasound: a systematic bibliometric analysis.
BMJ Open. 2017; 7(10): e015317. 2017 Oct 22. doi: 10.1136/-2016-015317
Sidiropoulou, T. Christodoulaki, K. Siristatidis, C. Pre-Procedural Lumbar Neuraxial Ultrasound—A Systematic Review of Randomized Controlled Trials and Meta-Analysis. Healthcare (Basel). 2021 Apr; 9(4): 479.
Hwang, B. Mampre, D. Ahmed, K. Suk, I. Anderson, W. Manbachi, A. Theodore, N. Ultrasound in Traumatic Spinal Cord Injury: A Wide-Open Field. Neurosurgery. 2021 Sep; 89(3): 372–382
Moreno, B. Barbosa, J. Ultrasound-Guided Procedures in the Cervical Spine. Cureus. 2021 Dec; 13(12): e20361
Fitzgerald, K. Ultrasound examination of the neonatal spine. Australas J Ultrasound Med. 2011 Feb; 14(1): 39–41
Feldkamp. M. Botto, L. Amar, E. Bakker, M. Bermejo, E. Bianca, S. Canfield, M. Castilla, E. Clementi, M. Csaky, M. Leoncini, Em. Li, Z. and more. Cloacal exstrophy: an epidemiologic study from the International Clearinghouse for Birth Defects Surveillance and Research. Review Am J Med Genet C Semin Med Genet. 2011 Nov 15;157C(4):333-43
Smith, C. Avansino, J. Anorectal Malformations. CME. 2023
Tan, L. Lopes, D. Fontes, R. Ultrasound-Guided Posterolateral Approach for Midline Calcified Thoracic Disc Herniation. J Korean Neurosurg Soc. 2014 Jun; 55(6): 383–386
Vasudeva, V. Abd, M. Pompeu, Y. Karhade, A. Groff, M Use of Intraoperative Ultrasound During Spinal Surgery. Global Spine J. 2017 Oct; 7(7): 648–656.
Harel, R. Knoller, M. Intraoperative spine ultrasound: application and benefits. Eur Spine J. 2016 Mar;25(3):865-9. doi: 10.1007/s00586-015-4222-5. Epub 2015 Sep 5