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64th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

26 - 29 May 2013, Düsseldorf

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Intraoperative myelography in cervical multilevel stenosis using 3D rotational fluoroscopy – assessment of feasibility, image quality and diagnostic value

Meeting Abstract

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  • Thomas Westermaier - Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik
  • Michael Kiderlen - Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik
  • Jörg Eriskat - Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik
  • Paul Pakos - Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik
  • Giles Hamilton Vince - Klinikum Klagenfurt, Abteilung für Neurochirurgie
  • Ralf-Ingo Ernestus - Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocP 126

doi: 10.3205/13dgnc543, urn:nbn:de:0183-13dgnc5439

Published: May 21, 2013

© 2013 Westermaier et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: To assess the feasibility and diagnostic value of intraoperative 3D-fluoroscopy for decompression control in patients with degenerative multilevel cervical stenosis.

Method: The series includes 8 patients with multilevel degenerative cervical stenosis. Prior to surgery, a lumbar drainage was placed for the intraoperative intrathecal administration of contrast agent. All patients were placed in a prone position and carbone Mayfield headholder. After posterior decompression, 10 ml of water-soluble contrast agent (Solutrast® 250) were administered via the lumbar drainage, the operating table tilted until repeated a.-p. or lateral fluoroscopy showed contrast filling of the cervical spinal canal. Thereafter, a 3D-fluoroscopy scan (Medtronic® O-Arm®) was performed and visually evaluated.

Results: All patients tolerated the administration well. The quality of multiplanar images was sufficient to supply information about the presence of residual stenosis. After prior instrumentation, metal artifacts lowered the image quality. In 3 cases, the decompression was continued because residual stenosis was depicted in the 3D rotational images.

Conclusions: Intraoperative myelography followed by 3D-rotational fluoroscopy is a highly useful tool for the control of surgical decompression in multilevel spinal stenosis supplying images comparable to postmyelographic CT. The indication might be expanded to other pathological conditions like tumor or trauma.