Intraosseous ultrasound for assessment of pedicle screw holes in the thoracolumbar spine based on endoscopic ultrasound: An experimental study - Scorecard - MDSpire
Clinical Scorecard: Evaluation of Pedicle Screw Holes in the Thoracolumbar Spine Using Intraosseous Ultrasound: An Experimental Approach Inspired by Endoscopic Techniques
At a Glance
Category
Detail
Condition
Misplacement of pedicle screws causing cortical bone damage and potential spinal instability or injury
Key Mechanisms
Intraosseous ultrasound (IOUS) using an endoscopic ultrasound (EUS) probe placed within pedicle screw holes to assess screw placement accuracy and bone channel integrity
Intraoperative surgical environment, particularly in spinal fusion procedures
Key Highlights
Misplaced pedicle screws can cause spinal instability and injury to surrounding tissues including blood vessels, nerves, and spinal cord.
IOUS with EUS probes offers a simple, rapid, and interpretable method to assess pedicle screw hole integrity intraoperatively without extensive training or complex equipment.
Existing advanced technologies (3D templates, DSG, CBCT, robotic navigation, AR/MR, photoacoustic imaging) reduce screw malposition rates but face limitations such as radiation exposure, cost, and lack of consensus on superiority.
Guideline-Based Recommendations
Diagnosis
Use intraosseous ultrasound (IOUS) with miniaturized EUS probes intraoperatively to assess pedicle screw hole placement accuracy.
Management
Consider IOUS as an adjunct to traditional free-hand or image-guided pedicle screw placement to reduce malposition risks.
Employ EUS probes for real-time 360° 2D transverse imaging of pedicle screw holes during surgery.
Monitoring & Follow-up
Monitor screw hole integrity intraoperatively using IOUS to detect cortical breaches or deviations from intended trajectories promptly.
Risks
Be aware of potential image distortions with flexible IVUS catheters; EUS probes may reduce this risk due to less tip bending.
Consider cost and availability of disposable catheters versus reusable EUS probes.
Patient & Prescribing Data
Patients undergoing thoracolumbar spinal fusion with pedicle screw instrumentation
IOUS with EUS probes can be performed rapidly (under 1 minute per screw hole) and may improve intraoperative detection of screw misplacement, potentially reducing revision surgeries.
Clinical Best Practices
Use caprine thoracolumbar spine models for experimental validation due to anatomical similarity to humans.
Prepare pedicle screw holes with intentional deviations to test IOUS sensitivity and reliability.
Select EUS probes with small diameter (~2.4 mm) and lateral ultrasound transducer placement for optimal intraosseous imaging.
Incorporate IOUS into minimally invasive spine surgery (MISS) workflows to provide rapid feedback without extensive additional training or personnel.
