Real-time ultrasound-computed tomography image fusion for transforaminal lumbar approach: a lumbosacral spine phantoms study

Guntz Emmanuel, Pourveur Arnaud, Gouwy Jonathan, Renard Marie, Mocanu Iulia, Pather Sanjiva, Fils Jean-François, Vannieuwenhove Olivier

May 2021, Volume 30, Issue 5, pp 1270 - 1276 Original Article Read Full Article

First Online: 13 March 2021

Purpose

Ultrasound (US) is increasingly used for transforaminal approaches. We evaluated whether fusing computed tomography (CT) images with dynamic US could be based on bony and surface landmarks in two phantom models.

Methods

Recordings were performed in a gelatin-based sonographic phantom and in a computerized imaging reference system training phantom. Three anesthesiologists performed 10 US and CT image fusions via three different techniques: (1) using locations of the fifth lumbar vertebra (L5) spinous process and the two posterior superior iliac spines in both images, (2) using the two lateral edges of the laminae rather than posterior superior iliac spines, and (3) using skin landmarks. Techniques were compared using values of precision (High quality of fusion: VP inferior to 10). Three punctures targeting the L4-L5 right foramina were made, and needle positions were checked using X-ray.

Results

Sixty fusions were performed in the gelatin phantom and 90 in the training phantom. VPs values of the 150 fusions were inferior to 5. Technique 2 was superior to one [operator 1: VP: 1.12 ± 0.54 vs. 2.38 ± 1.49; operator 2: 0.6 ± 0.39 vs. 3.66 ± 1.22; operator 3: 0.89 ± 0.31 vs. 1.23 ± 0.63 (p

Conclusion

Bony and surface landmarks allowed for accurate fusion of CT and US images of the lumbar spine. These techniques, performed on phantoms, allowed for precise localization and puncturing of lumbar neural foramina.

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