Limits...
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

Sagittal (a) and transverse (b) view of intraoperative myelography after anterior and posterior decompression. The images were acquired after posterior instrumentation and depict the susceptibility to metal artifacts.
© Copyright Policy - open-access
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4537761&req=5

fig3: Sagittal (a) and transverse (b) view of intraoperative myelography after anterior and posterior decompression. The images were acquired after posterior instrumentation and depict the susceptibility to metal artifacts.

Mentions: Image quality was excellent if 3D scans were acquired prior to metal implantation (Figures 2(a) and 2(b)). Contrast enhancement was better in posterior approaches than in anterior approaches. Metal artifacts considerably reduced image quality, especially in posterior procedures (Figures 3(a) and 3(b)). Caspar-pins used for vertebral distraction in anterior approaches also caused strong metal artifacts and reduced image quality (Figures 4(a)–4(d)). The results of the assessment of image quality and the operative consequences drawn from intraoperative myelography are depicted in Table 1. In four of the 10 procedures, the operative strategy was changed after the evaluation of intraoperative myelograms.


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)

Sagittal (a) and transverse (b) view of intraoperative myelography after anterior and posterior decompression. The images were acquired after posterior instrumentation and depict the susceptibility to metal artifacts.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig3: Sagittal (a) and transverse (b) view of intraoperative myelography after anterior and posterior decompression. The images were acquired after posterior instrumentation and depict the susceptibility to metal artifacts.
Mentions: Image quality was excellent if 3D scans were acquired prior to metal implantation (Figures 2(a) and 2(b)). Contrast enhancement was better in posterior approaches than in anterior approaches. Metal artifacts considerably reduced image quality, especially in posterior procedures (Figures 3(a) and 3(b)). Caspar-pins used for vertebral distraction in anterior approaches also caused strong metal artifacts and reduced image quality (Figures 4(a)–4(d)). The results of the assessment of image quality and the operative consequences drawn from intraoperative myelography are depicted in Table 1. In four of the 10 procedures, the operative strategy was changed after the evaluation of intraoperative myelograms.

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