Application of Intra Operative Ultrasound in Spine Surgery

Volume 3 | Issue 2 | October 2022-March 2023 | page: 51-54 | Rakeshkumar C. Luhana, Jinil N. Doshi


Authors: Rakeshkumar C. Luhana [1], Jinil N. Doshi [1]

[1] Department of Spine Surgery, Venus Superspeciality Hospital, Vadodara, Gujarat, India.

Address of Correspondence

Dr. Rakeshkumar Luhana,
Department of Spine Surgery, Venus Superspeciality Hospital, Vadodara, Gujarat, India.


Objective: Intraoperative ultrasound is a real time imaging modality. Though was introduced in 1980s, not widely used. It is applicable for Intradural lesions as well as pathology ventral to cord, while doing posterior approach and helps us to make surgery safer. Our objective is to share technique as well as our experience of intra operative ultrasound by sharing illustrative cases.
Method: our Surgical cases were reviewed and identified cases where we used intraoperative ultrasound. Illustrative cases were selected and compiled.
Results: This article describes technique of intra operative ultrasound and several illustrative cases were demonstrated.
Conclusion: Intraoperative ultrasound is a real time imaging tool and can be used for various indications especially for intradural lesions and addressing ventral pathology from posterior routes.
Keywords: Intra operative ultrasound, Real time imaging, Intra operative adjunct


1. Dohrmann GJ, Rubin JM. Intraoperative ultrasound imaging of the spinal cord: syringomyelia, cysts, and tumors—a preliminary report. Surg Neurol. 1982;18:395–399.
2. Braun IF, Raghavendra BN, Kricheff II. Spinal cord imaging using real-time high-resolution ultrasound. Radiology. 1983;147:459–465.
3. Knake JE, Gabrielsen TO, Chandler WF, Latack JT, Gebarski SS, Yang PJ. Real-time sonography during spinal surgery. Radiology. 1984;151:461–465.
4. Rubin JM, Dohrmann GJ. The spine and spinal cord during neurosurgical operations: real-time ultrasonography. Radiology. 1985;155:197–200.
5. Montalvo BM, Quencer RM. Intraoperative sonography in spinal surgery: current state of the art. Neuroradiology. 1986;28:551–590.
6. Pasto ME, Rifkin MD, Rubenstein JB, Northrup BE, Cotler JM, Goldberg BB. Real-time ultrasonography of the spinal cord: intraoperative and postoperative imaging. Neuroradiology. 1984;26:183–187.
7. Quencer RM, Montalvo BM, Eismont FJ, Green BA. Intraoperative spinal sonography in thoracic and lumbar fractures: evaluation of Harrington rod instrumentation. AJR Am J Roentgenol. 1985;145:343–349.
8. Quencer RM, Montalvo BM, Green BA, Eismont FJ. Intraoperative spinal sonography of soft-tissue masses of the spinal cord and spinal canal. AJR Am J Roentgenol. 1984;143:1307–1315.
9. Quencer RM, Morse BM, Green BA, Eismont FJ, Brost P. Intraoperative spinal sonography: adjunct to metrizamide CT in the assessment and surgical decompression of posttraumatic spinal cord cysts. AJR Am J Roentgenol. 1984;142:593–601.
10. Rubin JM, Dohrmann GJ. Work in progress: intraoperative ultrasonography of the spine. Radiology. 1983;146:173–175.
11. McGahan JP, Benson D, Chehrazi B, Walter JP, Wagner FC., Jr Intraoperative sonographic monitoring of reduction of thoracolumbar burst fractures. AJR Am J Roentgenol. 1985;145:1229–1232.
12. Sosna J, Barth MM, Kruskal JB, Kane RA. Intraoperative sonography for neurosurgery. J Ultrasound Med. 2005;24:1671–1682.
13. Toktas ZO, Sahin S, Koban O, Sorar M, Konya D. Is intraoperative ultrasound required in cervical spinal tumors? A prospective study. Turk Neurosurg. 2013;23:600–606.
14. Harel R, Knoller N. Intraoperative spine ultrasound: application and benefits. Eur Spine J. 2016;25:865–869..
15. Prada F, Vetrano IG, Filippini A, et al. Intraoperative ultrasound in spinal tumor surgery. J Ultrasound. 2014;17:195–202.
16. Zhou H, Miller D, Schulte DM, et al. Intraoperative ultrasound assistance in treatment of intradural spinal tumours. Clin Neurol Neurosurg. 2011;113:531–537.
17. Bozinov O, Burkhardt JK, Woernle CM, et al. Intra-operative high frequency ultrasound improves surgery of intramedullary cavernous malformations. Neurosurg Rev. 2012;35:269–275.
18. Sciubba DM, Liang D, Kothbauer KF, Noggle JC, Jallo GI. The evolution of intramedullary spinal cord tumor surgery. Neurosurgery. 2009;65:84–91.
19. Regelsberger J, Fritzsche E, Langer N, Westphal M. Intraoperative sonography of intra-and extramedullary tumors. Ultrasound Med Biol. 2005;31:593–598.
20. Iacopino DG, Conti A, Giusa M, Cardali S, Tomasello F. Assistance of intraoperative microvascular doppler in the surgical obliteration of spinal dural arteriovenous fistula: cases description and technical considerations. Acta Neurochir. 2003;145:133–137.
21. Friedman JA, Wetjen NM, Atkinson JL. Utility of intraoperative ultrasound for tumors of the Cauda equina. Spine (Phila Pa 1976). 2003;28:288–290.
24. Tekula F, Pritz MB, Kopecky K, Willing SJ. Usefulness of color Doppler ultrasound in the management of a spinal arteriovenous fistula. Surg Neurol. 2001;56:304–307.
25. Lunardi P, Acqui M, Ferrante L, Fortuna A. The role of intraoperative ultrasound imaging in the surgical removal of intramedullary cavernous angiomas. Neurosurgery. 1994;34:520–523.
26. Matsuzaki H, Tokuhashi Y, Wakabayashi K, Toriyama S. Clinical values of intraoperative ultrasonography for spinal tumors. Spine (Phila Pa 1976). 1992;17:1392–1399.
27. Kawakami N, Mimatsu K, Kato F. Intraoperative sonography of intramedullary spinal cord tumours. Neuroradiology. 1992;34:436–439.
28. Epstein FJ, Farmer JP, Schneider SJ. Intraoperative ultrasonography: an important surgical adjunct for intramedullary tumors. J Neurosurg. 1991;74:729–733.
29. Platt JF, Rubin JM, Chandler WF, Bowerman RA, DiPietro MA. Intraoperative spinal sonography in the evaluation of intramedullary tumors. J Ultrasound Med. 1988;7:317–325.
30. Harrop JS, Ganju A, Groff M, Bilsky M. Primary intramedullary tumors of the spinal cord. Spine (Phila Pa 1976). 2009;34(22 suppl):S69–S77.
31. Nishimura Y, Thani NB, Tochigi S, Ahn H, Ginsberg HJ. Thoracic discectomy by posterior pedicle-sparing, transfacet approach with real-time intraoperative ultrasonography: clinical article. J Neurosurg Spine. 2014;21:568–576.
32. Seichi A, Chikuda H, Kimura A, et al. Intraoperative ultrasonographic evaluation of posterior decompression via laminoplasty in patients with cervical ossification of the posterior longitudinal ligament: correlation with 2-year follow-up results. J Neurosurg Spine. 2010;13:47–51.
33. Aoyama T, Hida K, Akino M, Yano S, Iwasaki Y. Detection of residual disc hernia material and confirmation of nerve root decompression at lumbar disc herniation surgery by intraoperative ultrasound. Ultrasound Med Biol. 2009;35:920–927.
34. Tokuhashi Y, Matsuzaki H, Oda H, Uei H. Effectiveness of posterior decompression for patients with ossification of the posterior longitudinal ligament in the thoracic spine: usefulness of the ossification-kyphosis angle on MRI. Spine (Phila Pa 1976). 2006;31:E26–E30.
35. Mueller LA, Degreif J, Schmidt R, et al. Ultrasound-guided spinal fracture repositioning, ligamentotaxis, and remodeling after thoracolumbar burst fractures. Spine (Phila Pa 1976). 2006;31:E739–E746.
36. Matsuyama Y, Kawakami N, Yanase M, et al. Cervical myelopathy due to OPLL: clinical evaluation by MRI and intraoperative spinal sonography. J Spinal Disord Tech. 2004;17:401–404.
37. Lazennec JY, Saillant G, Hansen S, Ramare S. Intraoperative ultrasonography evaluation of posterior vertebral wall displacement in thoracolumbar fractures. Neurol Med Chir (Tokyo). 1999;39:8–14.
38. Blumenkopf B, Daniels T. Intraoperative ultrasonography (IOUS) in thoracolumbar fractures. J Spinal Disord. 1988;1:86–93.
39. Randel S, Gooding GA, Dillon WP. Sonography of intraoperative spinal arteriovenous malformations. J Ultrasound Med. 1987;6:539–544.
40. Viren s, Muhammad A, Yuri a et al. Use of intraoperative ultrasound in spine surgery. Global Spine Journal.2017;7(7);648-656
41. Mario G, Nikolaos S, Allan R et al. Intraoperative ultrasound in Spine surgery: history, current applications, future developments. Quant Imaging Med Surg 2018;8(3):261-267
42. Ahmed A, Hussam A, Alaa A et al. The utility of ultrasound for surgical spinal decompression. Med Ultrason 2015;17(2): 211-218

How to Cite this Article: Luhana R, Doshi J |  Application of Intra Operative Ultrasound in Spine Surgery | Back Bone: The Spine Journal | October 2022-March 2023; 3(2): 51-54.

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