J Neurol Surg A Cent Eur Neurosurg 2015; 76 - A008
DOI: 10.1055/s-0035-1566327

Intraoperative Ultrasound-Based Evaluation of the Extent of Posterior Lumbar Surgical Decompression

Yavor Enchev 1, T. Kondev 1, B. Iliev 1, P. L. Trendafilov 1, T. Avramov 1, Ferdi Kovach 1, Stephanie Todorova 1
  • 1Clinic of Neurosurgery, University Hospital “St. Marina,” Medical University of Varna, Varna, Bulgaria

Introduction Surgical treatment of lumbar spinal stenosis is recommended when other nonsurgical therapies have failed. Its unsatisfactory clinical outcomes most frequently are associated with insufficient degree of surgical decompression. The application of two-dimensional ultrasonography for real-time monitoring and guidance in these cases is not adequately studied.

Aim The purpose of this study was to assess the efficacy of the intraoperative ultrasound (US)-based evaluation of the extent of posterior decompression in the surgical treatment of lumbar spinal stenosis.

Materials and Methods Intraoperative US-based evaluation of the extent of posterior lumbar decompression was accomplished in 37 patients with lumbar stenosis during the study period of 7 months. The applied US probe was with wideband linear array 28 mm, 18 to 6 MHz. The patients in the series underwent laminectomy (36 cases) and hemilaminectomy (1 case) tailored individually by the real-time US-based inspection of the extent of nerve roots' decompression.

Results The intraoperative US-based evaluation of the extent of posterior lumbar decompression was sufficiently informative in all studied cases. The dural sac and its nerve roots were precisely visualized by the US imaging. The complete decompression of the spinal canal was objectively controlled by US imaging of the ventral epidural space, including the disc space and the degree of releasing the dural sac and the passing nerve roots. The symptoms were significantly reduced in all patients and no US imaging–associated complications were detected.

Conclusion The intraoperative US imaging is a reliable tool for assessment of the degree of nerve roots' decompression in case of lumbar spinal stenosis. US imaging provides the neurosurgeon with real-time objective intraoperative information which influences the extent of decompression. In this way, it provides reliable intraoperative control which most probably could influence the surgical outcomes.

Keywords lumbar stenosis; surgical decompression; intraoperative ultrasonography; extent of nerve roots decompression