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Intraoperative Myelography in Cervical Multilevel Stenosis Using 3D Rotational Fluoroscopy: Assessment of Feasibility and Image Quality.

Westermaier T, Koehler S, Linsenmann T, Kiderlen M, Pakos P, Ernestus RI - Radiol Res Pract (2015)

Bottom Line: Methods.Findings.The method is susceptible to metal artifacts and, therefore, should be applied before metal implants are placed.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, University Hospital Wuerzburg, Josef-Schneider-Strasse 11, 97080 Wuerzburg, Germany.

ABSTRACT
Background. Intraoperative myelography has been reported for decompression control in multilevel lumbar disease. Cervical myelography is technically more challenging. Modern 3D fluoroscopy may provide a new opportunity supplying multiplanar images. This study was performed to determine the feasibility and image quality of intraoperative cervical myelography using a 3D fluoroscope. Methods. The series included 9 patients with multilevel cervical stenosis. After decompression, 10 mL of water-soluble contrast agent was administered via a lumbar drainage and the operating table was tilted. Thereafter, a 3D fluoroscopy scan (O-Arm) was performed and visually evaluated. Findings. The quality of multiplanar images was sufficient to supply information about the presence of residual stenosis. After instrumentation, metal artifacts lowered image quality. In 3 cases, decompression was continued because myelography depicted residual stenosis. In one case, anterior corpectomy was not completed because myelography showed sufficient decompression after 2-level discectomy. Interpretation. Intraoperative myelography using 3D rotational fluoroscopy is useful for the control of surgical decompression in multilevel spinal stenosis providing images comparable to postmyelographic CT. The long duration of contrast delivery into the cervical spine may be solved by preoperative contrast administration. The method is susceptible to metal artifacts and, therefore, should be applied before metal implants are placed.

No MeSH data available.


Related in: MedlinePlus

Lateral fluoroscopic view depicting the contrast delivery into the cervical spinal canal.
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Related In: Results  -  Collection


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fig1: Lateral fluoroscopic view depicting the contrast delivery into the cervical spinal canal.

Mentions: After decompression, 10 mL of iodine contrast agent (Isovist 240) was administered via the lumbar drainage. Then, the operating table was tilted head down in order to allow the contrast agent to flow into the cervical canal until serial lateral or anteroposterior fluoroscopy using the 3D fluoroscope (O-Arm, Medtronic) showed the intrathecal contrast flow (Figure 1). When the cervical canal was filled with contrast agent, a 3D rotational fluoroscopy scan was performed. Thereafter, the table was readjusted and the operation continued. For 3D image acquisition, the following O-Arm settings were used: “High Definition Mode”; gantry tilt 0 degrees; gantry rotation 360 degrees; image acquisition time 24 seconds; reconstruction time 24 seconds; standard O-Arm collimator thickness without additional collimation; digital flat panel detector 40 × 30 cm, camera resolution 2000 × 1500 (3 megapixels); pixel pitch 0.194 mm; reconstruction matrix 512 × 512 × 192).


Intraoperative Myelography in Cervical Multilevel Stenosis Using 3D Rotational Fluoroscopy: Assessment of Feasibility and Image Quality.

Westermaier T, Koehler S, Linsenmann T, Kiderlen M, Pakos P, Ernestus RI - Radiol Res Pract (2015)

Lateral fluoroscopic view depicting the contrast delivery into the cervical spinal canal.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4537761&req=5

fig1: Lateral fluoroscopic view depicting the contrast delivery into the cervical spinal canal.
Mentions: After decompression, 10 mL of iodine contrast agent (Isovist 240) was administered via the lumbar drainage. Then, the operating table was tilted head down in order to allow the contrast agent to flow into the cervical canal until serial lateral or anteroposterior fluoroscopy using the 3D fluoroscope (O-Arm, Medtronic) showed the intrathecal contrast flow (Figure 1). When the cervical canal was filled with contrast agent, a 3D rotational fluoroscopy scan was performed. Thereafter, the table was readjusted and the operation continued. For 3D image acquisition, the following O-Arm settings were used: “High Definition Mode”; gantry tilt 0 degrees; gantry rotation 360 degrees; image acquisition time 24 seconds; reconstruction time 24 seconds; standard O-Arm collimator thickness without additional collimation; digital flat panel detector 40 × 30 cm, camera resolution 2000 × 1500 (3 megapixels); pixel pitch 0.194 mm; reconstruction matrix 512 × 512 × 192).

Bottom Line: Methods.Findings.The method is susceptible to metal artifacts and, therefore, should be applied before metal implants are placed.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, University Hospital Wuerzburg, Josef-Schneider-Strasse 11, 97080 Wuerzburg, Germany.

ABSTRACT
Background. Intraoperative myelography has been reported for decompression control in multilevel lumbar disease. Cervical myelography is technically more challenging. Modern 3D fluoroscopy may provide a new opportunity supplying multiplanar images. This study was performed to determine the feasibility and image quality of intraoperative cervical myelography using a 3D fluoroscope. Methods. The series included 9 patients with multilevel cervical stenosis. After decompression, 10 mL of water-soluble contrast agent was administered via a lumbar drainage and the operating table was tilted. Thereafter, a 3D fluoroscopy scan (O-Arm) was performed and visually evaluated. Findings. The quality of multiplanar images was sufficient to supply information about the presence of residual stenosis. After instrumentation, metal artifacts lowered image quality. In 3 cases, decompression was continued because myelography depicted residual stenosis. In one case, anterior corpectomy was not completed because myelography showed sufficient decompression after 2-level discectomy. Interpretation. Intraoperative myelography using 3D rotational fluoroscopy is useful for the control of surgical decompression in multilevel spinal stenosis providing images comparable to postmyelographic CT. The long duration of contrast delivery into the cervical spine may be solved by preoperative contrast administration. The method is susceptible to metal artifacts and, therefore, should be applied before metal implants are placed.

No MeSH data available.


Related in: MedlinePlus