gms | German Medical Science

Objective: Intraoperative imaging procedures increase patient safety and in combination with navigation systems are well established in spinal operations. Intraoperative MRI (ioMRI) is well established in cranial surgery. It has thus been possible to considerably reduce the number of reoperations and to increase patient safety. There are a few reports on the use of MRI in cervical spine surgery. No reports, however, have been published on imaging of the entire spine.

Methods: From 26 June 2013 to 21 November 2013, 23 ioMRI scans were performed on the spine of 21 patients. Depending on the indication, pre-operative and intraoperative scans were conducted. The scanner used is a Siemens Skyra 3T system for ultra-high-field imaging. The Combi Dockable Table is a patient transport solution developed by Maquet and Siemens which allows the patient to be transferred from the operating table to the MRI table by a shell system. It is therefore not necessary to move the patient or have a third transfer table. For imaging, flexible body coils are available from Siemens in different sizes and numbers.

Results: Cervical spine MRIs were performed on 7 patients, a thoracic spine MRI on one patient, and lumbar spine MRIs on 13 patients. Cervical and thoracic spine MRIs were performed with the head/neck coil of the MRI table. All 13 patients on whom lumbar spine MRIs were performed were in a prone position and were transferred directly. Patient transfer was safe for all 21 patients. Patients with a large body mass came close to the scanner tube as a result of the prone position and positioning aids. This impaired the quality of the images, especially in the axial layers. Surgery on two patients was continued on the basis of acquired images. Two other patients underwent two-stage surgery. In one patient the second operation was performed with ioMRI.

Conclusions: Our study has shown that sufficient imaging of the spine is possible and that safe intraoperative MRI scans are feasible thanks to the patient transfer system in our operating theatre. Further studies are required to show the extent to which surgical revisions can be reduced and the operations and diseases to which ioMRI lends itself.