Intraoperative 3-dimensional reconstructed multiplanar fluoroscopic imaging for immediate evaluation of spinal decompression.

Although thorough preoperative planning is the best method of achieving appropriate levels of lumbar spinal decompression, current methods for intraoperative assessment of the extent of spinal decompression are inadequate. Underdecompression leads to poor clinical outcomes and overdecompression can lead to instability. The purpose of this study is to evaluate the use of multiplanar, fluoroscopic images reconstructed in 3-dimensional format, combined with spinal myelography to intraoperatively assess lumbar spinal decompression. Patients scheduled for lumbar spinal decompression surgery were recruited for intraoperative evaluation using multiplanar imaging and myelography. After performing the minimal necessary decompression of the preoperatively planned areas of spinal stenosis, 13 mL of omnipaque contrast dye was injected into the subarachnoid space. Iso-C sequential fluoroscopic images were acquired and reconstructed into multiplanar images. Images were evaluated for quality, and spinal decompression was evaluated for completeness. The average time for this technique was 13 minutes 42 seconds (range, 9 min 59 s to 19 min 57 s). The average time for injecting the dye was 3 minutes 3 seconds and for assessing the images was 3 minutes 24 seconds. There was a notable decrease in the time required for the technique as the surgeon and staff became more proficient at the procedure. All patients had adequate visualization of the spinal canal and nerve roots. Three patients had additional decompression after review of the images. It is feasible to obtain multiplanar myelograph enhanced C-arm fluoroscopic images in the operating room setting and these are useful for the evaluation of decompression of lumbar spinal stenosis.