Murata Shizumasa, Iwasaki Hiroshi, Hashizume Hiroshi, Yukawa Yasutsugu, Minamide Akihito, Nakagawa Yukihiro, Tsutsui Shunji, Takami Masanari, Okada Motohiro, Nagata Keiji, Ishimoto Yuyu, Teraguchi Masatoshi, Iwahashi Hiroki, Murakami Kimihide, Taiji Ryo, Kozaki Takuhei, Kitano Yoji, Yoshida Munehito, Yamada Hiroshi
Department of Orthopedic Surgery, Shingu Municipal Medical Center, Shingu, Japan.
Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan.
Spine Surg Relat Res. 2024 Feb 14;8(4):433-438. doi: 10.22603/ssrr.2023-0268. eCollection 2024 Jul 27.
Postoperative spinal epidural hematoma (PSEH) is a severe complication of spinal surgery that necessitates accurate and timely diagnosis. This study aimed to assess the accuracy of ultrasonography as an alternative diagnostic tool for PSEH after microendoscopic laminotomy (MEL) for lumbar spinal stenosis, comparing it with magnetic resonance imaging (MRI).
A total of 65 patients who underwent MEL were evaluated using both ultrasound- and MRI-based classifications for PSEH. Intra- and interrater reliabilities were analyzed. Furthermore, ethical standards were strictly followed, with spine surgeons certified by the Japanese Orthopaedic Association performing evaluations.
Among the 65 patients, 91 vertebral segments were assessed. The intra- and interrater agreements for PSEH classification were almost perfect for both ultrasound (κ=0.824 [95% confidence interval (CI) 0.729-0.918] and κ=0.810 [95% CI 0.712-0.909], respectively) and MRI (κ=0.839 [95% CI 0.748-0.931] and κ=0.853 [95% CI 0.764-0.942], respectively). The results showed high concordance between ultrasound- and MRI-based classifications, validating the reliability of ultrasound in postoperative PSEH evaluation.
This study presents a significant advancement by introducing ultrasound as a precise and practical alternative to MRI for PSEH evaluation. The comparable accuracy of ultrasound to MRI, rapid bedside assessments, and radiation-free nature make it valuable for routine postoperative evaluations. Despite the limitations related to specific surgical contexts and clinical outcome assessment, the clinical potential of ultrasound is evident. It offers clinicians a faster, cost-effective, and repeatable diagnostic option, potentially enhancing patient care. This study establishes the utility of ultrasound in evaluating postoperative spinal epidural hematomas after MEL. With high concordance to MRI, ultrasound emerges as a reliable, practical, and innovative tool, promising improved diagnostic efficiency and patient outcomes. Further studies should explore its clinical impact across diverse surgical scenarios.
术后脊柱硬膜外血肿（PSEH）是脊柱手术的一种严重并发症，需要准确及时的诊断。本研究旨在评估超声作为腰椎管狭窄症显微内镜下椎板切开术（MEL）后PSEH的替代诊断工具的准确性，并与磁共振成像（MRI）进行比较。
共有65例行MEL的患者接受了基于超声和MRI的PSEH分类评估。分析了评估者内和评估者间的可靠性。此外，严格遵循伦理标准，由日本骨科协会认证的脊柱外科医生进行评估。
在65例患者中，评估了91个椎体节段。PSEH分类的评估者内和评估者间一致性在超声（分别为κ=0.824[95%置信区间（CI）0.729 - 0.918]和κ=0.810[95%CI 0.712 - 0.909]）和MRI（分别为κ=0.839[95%CI 0.748 - 0.931]和κ=0.853[95%CI 0.764 - 0.942]）方面几乎都非常好。结果显示基于超声和MRI的分类之间具有高度一致性，验证了超声在术后PSEH评估中的可靠性。
本研究通过引入超声作为MRI用于PSEH评估的精确且实用的替代方法取得了重大进展。超声与MRI相当的准确性、快速的床边评估以及无辐射的特性使其在术后常规评估中具有价值。尽管存在与特定手术背景和临床结果评估相关的局限性，但超声的临床潜力是明显的。它为临床医生提供了一种更快、成本效益更高且可重复的诊断选择，有可能改善患者护理。本研究确立了超声在评估MEL术后脊柱硬膜外血肿中的效用。由于与MRI高度一致，超声成为一种可靠、实用且创新的工具，有望提高诊断效率和改善患者预后。进一步的研究应探讨其在不同手术场景中的临床影响。
