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Enhanced Safety of Pedicle Subtraction Osteotomy Using Intraoperative Ultrasound
- Source :
- World neurosurgery. 152
- Publication Year :
- 2021
-
Abstract
- Background Pedicle subtraction osteotomy (PSO) can improve sagittal alignment but carries risks, including iatrogenic spinal cord and nerve root injury. Critically, during the reduction phase of the technique, medullary kinking or neural element compression can lead to neurologic deficits. Methods We describe 3 cases of thoracic PSO and evaluate the feasibility, findings, and utility of intraoperative ultrasound in this setting. Results Intraoperative ultrasound can provide a visual assessment of spinal cord morphology before and after PSO reduction and influences surgical decision making with regard to the final amount of sagittal plane correction. This modality is particularly useful for confirming ventral decompression of disc–osteophyte complex before reduction and also after reduction maneuvers when there is kinking of the thecal sac but uncertainty about the underlying status of the spinal cord. Intraoperative ultrasound is a reliable modality that fits well into the technical sequence of PSO, adds a minimal amount of operative time, and has few limitations. Conclusions We propose that intraoperative ultrasound is a useful supplement to standard neuromonitoring modalities for ensuring safe PSO reduction and decompression of neural elements.
- Subjects :
- Adult
medicine.medical_specialty
Medullary cavity
Decompression
medicine.medical_treatment
Clinical Decision-Making
Osteotomy
Neurosurgical Procedures
03 medical and health sciences
0302 clinical medicine
Monitoring, Intraoperative
medicine
Humans
Kyphosis
Reduction (orthopedic surgery)
Ultrasonography, Interventional
Aged
business.industry
Subtraction
Middle Aged
Spinal cord
Sagittal plane
Spine
medicine.anatomical_structure
Spinal Cord
030220 oncology & carcinogenesis
Surgery
Female
Neurology (clinical)
Thecal sac
Radiology
business
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 18788769
- Volume :
- 152
- Database :
- OpenAIRE
- Journal :
- World neurosurgery
- Accession number :
- edsair.doi.dedup.....51bd00c24a757baf7b9549ba6e65a3c4