Intraoperative Ultrasound in Spine Decompression Surgery

A Systematic Review

Jimmy Tat, MD, MSc; Jessica Tat, MD; Samuel Yoon, MD, MSc; Albert J.M. Yee, MD, MSc, FRCSC, DABOS; Jeremie Larouche, MD, FRCSC


Spine. 2022;47(2):E73-E85. 

In This Article


Search Strategy

We conducted a systematic search of multiple databases that included: Medline, Embase, and Cochrane Central Register of Controlled Trials Strategy to include citations from inception to May 2019, to help identify all studies that examined the intraoperative use of ultrasound imaging in spinal decompression surgery. Our search terms included spine, spinal cord diseases, decompression surgery, ultrasonography, and intraoperative period. The search was restricted to English and human studies. We then hand-searched the references of relevant studies.

Study Selection

We were interested in investigating the operational definition for adequate decompression of the spine using IOUS. Inclusion criteria consisted of studies that used ultrasound intraoperatively to guide surgical decompression of the spinal cord and/or nerve roots in the cervical, thoracic, and lumbar spine. We included decompression cases that were performed on degenerative disease, trauma, and extra-dural tumor cases. We excluded intradural conditions such as arachnoid cyst, syringomyelia, hemangioma, spinal arte-riovenous malformations, and intradural spinal cord tumors (intramedullary and extramedullary). Studies were also excluded if they used modalities of ultrasound that were nonimaging related (such as ultrasound-guided pulsed-radio frequency, laser Doppler flowmetry, ultrasonic bone curette,) or nondiagnostic ultrasound modes (e.g., 3-dimensional ultrasound, microvascular Doppler, power Doppler). We did not include studies that used ultrasound-guidance for anesthetic blocks or injections (e.g., thoracolumbar interfascial plane block, lumbar plexus blocks, facet joint anesthetic, or steroid infiltrations).

Data Extraction

The data were extracted by two independent reviewers. Any disagreements were resolved by the corresponding author. Extracted data include study characteristics, study population, demographics and clinical characteristics, statistical analyses, correlation to clinical outcomes and other imaging modalities, and reliability measures (intraobserver or interobserver reliability). The QUADAS tool was used to assess risk of bias for nonrandomized control trials.

Risk of bias assessment was performed using the Methodological Index for Non-Randomized Studies (MINORS) tool.[12] We used the MINORS scoring system consisting of eight items for noncomparative studies, each item was scored 0 (not reported), 1 (reported but inadequate), or 2 (reported and adequate).