ULTRASOUND-GUIDED SPINAL FRACTURE REPOSITIONING

The management of narrowing spinal fragments in the operative treatmen t of spinal fractures remains an open question, in particular when the procedure is performed by a posterior approach. This article describe s the use of intraoperative ultrasonography during spinal surgery. Fro m 1990 to 1997, 116 spinal fractures were treated operatively at our c linic. Stabilization of the spine was achieved with the AO fixateur in terne and the AO USS, respectively (Synthes, D-79224, Umkirch, Germany ). For 60 cases who had a fractured posterior vertebral surface disloc ated into the spinal canal, we used intraoperative ultrasonography to monitor the repositioning of the narrowing fragments. The patients und erwent pre- and postoperative computed tomography scans (CT). In six c ases, color-coded duplex sonography was performed intraoperatively to view the A. spinalis anterior. In 58 cases, the spinal canal and the f ractured posterior surface of the vertebrae were visualized successful ly. The sonographic image was inconclusive in two cases with severely damaged fragments. Identical findings were observed on the intraoperat ive ultrasound image after completion of repositioning and on the post operative CT scan. In six cases, the A. spinalis anterior was viewed b y color-coded duplex sonography with a different flow before and after fracture repositioning. Intraoperative ultrasound is a valuable means of monitoring the restoration of the spinal canal by a posterior appr oach. The method is easy to perform and can be repeated as often as re quired. Color-coded duplex sonography allows further visualization of the A. spinalis anterior.