The feasibility and utility of intraoperative ultrasound in spinal cord injury patients: an international survey of AO spine members

Study design: Survey. Objectives: Intraoperative ultrasound (IOUS) is an emerging tool for assessing the injured spinal cord during surgical intervention and particularly after traumatic spinal cord injury (SCI). The extent of utilization of this technique is unknown. To assess whether a knowledge gap exists regarding IOUS in managing SCI patients, an international survey of spine surgeons was performed. Setting: International Survey. Methods: Members of the AO Spine international community were surveyed using a web-based questionnaire developed by an SCI expert commission. The categorical data were analyzed descriptively. Results: Of the 276 completed surveys, 22% (n = 61/276) indicated IOUS was utilized during spine surgery, with most responses coming from Europe (38% n = 24/61) and North America (30% n = 18/61). Only 41% (n = 25/61) had received formal IOUS training. There were 59% (n = 36/61) of respondents who indicated they use IOUS on patients with acute SCI, mainly to assess adequate decompression. Of those not using IOUS, 50% (n = 107/215) did not have access to an ultrasound machine available. Overall, 92% (n = 254/276) indicated that an IOUS training course would be beneficial to improve understanding and patient care. Conclusions: This international survey of spine surgeons demonstrated that currently, there is limited use of IOUS in the surgical management of acute SCI. Understanding the needs of spine surgeons and tailoring educational opportunities may increase the role of IOUS. Given the importance of surgical decompression in enhancing outcomes after acute SCI coupled with the ability of IOUS to assess decompression, greater adoption of IOUS could further enhance the efficacy of decompressive surgery.