Detection of Residual Disc Hernia Material and Confirmation of Nerve Root Decompression at Lumbar Disc Herniation Surgery by Intraoperative Ultrasound

Aoyama, Takeshi; Hida, Kazutoshi; Akino, Minoru; Yano, Shunsuke; Iwasaki, Yoshinobu

Detection of Residual Disc Hernia Material and Confirmation of Nerve Root Decompression at Lumbar Disc Herniation Surgery by Intraoperative Ultrasound

Aoyama, Takeshi; Hida, Kazutoshi; Akino, Minoru et al.

Ultrasound in Medicine & Biology, 2009, 35(6), 920-927

Permalink : https://hdl.handle.net/2115/38757

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アクセス権	open access
URI	https://hdl.handle.net/2115/38757
タイトル	Detection of Residual Disc Hernia Material and Confirmation of Nerve Root Decompression at Lumbar Disc Herniation Surgery by Intraoperative Ultrasound
著者	Aoyama, Takeshi ; Hida, Kazutoshi ; Akino, Minoru ; Yano, Shunsuke ; Iwasaki, Yoshinobu
著者名 Aoyama, Takeshi
著者名 Hida, Kazutoshi
著者名 Akino, Minoru
著者名 Yano, Shunsuke
著者名 Iwasaki, Yoshinobu
言語	英語
キーワード	Echography
	Intraoperative
	Lumbar disc herniation
	Ultrasonography
	Ultrasound
発行日	2009-06
出版者	Elsevier Inc.
収録物名	Ultrasound in Medicine & Biology
巻(号)	35(6)
ページ	920-927
抄録	The aim of lumbar disc herniation surgery is the removal of herniated disc material (HDM) and complete decompression of the nerve root. As some patients present with residual HDM, we examined the ability of intraoperative ultrasound (IOUS) to detect this material. Between February 2006 and June 2007, we used IOUS in 30 patients undergoing surgery for lumbar disc herniation. They were 17 men and 13 women; their ages ranged from 22 to 63 years (mean 44.0). The level surgically addressed was L3/4 in 1-, L4/5 in 14-, and L5/S1 in 15 patients; they were operated in the prone position. After placing a 3-4 cm midline skin incision, partial hemi-semilaminotomy was performed. HDM was removed through a bone window; a surgical microscope was used during the operation. After removal was judged as adequate, IOUS was performed; 17 patients also underwent IOUS before removal of the herniated disc. For the acquisition of IOUS images we used LOGIQ 9 and 8c microconvex probes (GE Healthcare, USA). The normal anatomical structures were well-visualized. HDM was iso- to high-echoic compared to normal nerve tissue. In 3 of 17 patients the dural sac and nerve root could not be distinguished from HDM before removal although in all 30 the decompressed dural sac, intradural cauda equina, and nerve root were well visualized. We posit that the echogenicity of nerve tissue was raised due to compression, rendering it similar to that of the herniated disc. In 2 patient IOUS detected residual disc material; the surgical procedure was resumed and sufficient removal was accomplished. IOUS monitoring is safe, convenient and inexpensive. It is also highly useful for the detection of residual HDM and the confirmation of adequate nerve root decompression.
資源タイプ	学術雑誌論文
出版タイプ	Accepted Manuscript
PISSN	0301-5629
関連情報	PMID 19376637
関連情報 (isVersionOf)	出版社版DOI https://doi.org/10.1016/j.ultrasmedbio.2008.12.014