Division of Orthopedic Surgery, University of Toronto, Toronto, Canada.
Department of Emergency Medicine, University of Ottawa, Ottawa, Canada.
Spine (Phila Pa 1976). 2022 Jan 15;47(2):E73-E85. doi: 10.1097/BRS.0000000000004111.
Systematic review.
The aim of this study was to review the current spine surgery literature to establish a definition for adequate spine decompression using intraoperative ultrasound (IOUS) imaging.
IOUS remains one of the few imaging modalities that allows spine surgeons to continuously monitor the spinal cord in real-time, while also allowing visualization of surrounding soft tissue anatomy during an operation. Although this has valuable applications for decompression surgery in spinal canal stenosis, it remains unclear how to best characterize adequacy of spinal decompression using IOUS.
We conducted a systematic search of multiple databases including: Medline, Embase, and Cochrane Central Register of Controlled Trials Strategy. Our search terms were spine, spinal cord diseases, decompression surgery, ultrasonogra-phy, and intraoperative period. We were interested in studies that used intraoperative use of ultrasound imaging in spinal decompression surgery for the cervical, thoracic, and lumbar spine. Study quality was evaluated using the Methodological Index for Non-Randomized Studies (MINORS).
Our search strategy yielded 985 of potentially relevant publications, 776 underwent title and abstract screening, and 31 full-text articles were reviewed. We found IOUS to be useful in spine surgery for decompression of degenerative cases in all regions of the spine. The thoracic spine was unique for IOUS-guided decompression of fractures, and the lumbar spine for decompressing nerve roots. Although we did not identify a universal definition for adequate decompression, there was common description of decompression that qualitatively described the ventral aspect of the spinal cord being "free floating" within the cerebrospinal fluid. Other measurable definitions, such as spinal cord diameter or spinal cord pulsatility, were not good definitions given there was insufficient evidence and/or poor reliability.
The systematic review examines the current literature on IOUS and spinal decompression surgery. We identified a common qualitative definition for adequate decompression involving a "free floating" spinal cord within the cerebrospinal fluid which indicates that the spinal cord is free from contact of the anterior elements.Level of Evidence: 1.
系统评价。
本研究旨在回顾当前的脊柱外科文献，以确定术中超声（IOUS）成像用于充分减压的定义。
IOUS 仍然是少数允许脊柱外科医生实时连续监测脊髓的影像学手段之一，同时也允许在手术过程中观察周围软组织解剖结构。尽管这对于脊髓管狭窄症的减压手术有宝贵的应用价值，但如何使用 IOUS 来最佳描述减压的充分性仍不清楚。
我们对多个数据库进行了系统搜索，包括：Medline、Embase 和 Cochrane 对照试验中心注册库。我们的搜索词包括脊柱、脊髓疾病、减压手术、超声、术中时期。我们对使用术中超声成像进行颈椎、胸椎和腰椎减压手术的研究感兴趣。使用非随机研究方法学指数（MINORS）评估研究质量。
我们的搜索策略产生了 985 篇可能相关的出版物，对 776 篇进行了标题和摘要筛选，并对 31 篇全文文章进行了审查。我们发现 IOUS 在脊柱外科中对所有脊柱区域的退行性病例减压都很有用。胸椎在 IOUS 引导下对骨折进行减压是独特的，而腰椎则用于减压神经根。尽管我们没有确定充分减压的通用定义，但对于减压的定性描述，即脊髓的腹侧在脑脊液中“自由漂浮”，有共同的描述。其他可衡量的定义，如脊髓直径或脊髓搏动性，由于证据不足和/或可靠性差，并不是好的定义。
系统评价检查了关于 IOUS 和脊柱减压手术的当前文献。我们确定了一个共同的定性定义，即充分减压涉及脊髓在脑脊液中“自由漂浮”，这表明脊髓不受前元素的接触。证据水平：1.
