Dr. Rolf M. Schwiete Stiftung

Intraoperative ultrasound of the spine has been used in neurosurgery (tumours) and traumatology (reposition of fractured vertebral bodies fragments). To describe initial experiences with this method and to document the opportunities and problems. 24 nucleotomies were documented and evaluated. Sonography was performed using a 7.5 MHz sector probe and a typical surgical approach. In 21 of 24 cases, imaging of intraspinal structures was possible. The complete extraction of the herniated disk could be documented. In 3 cases the examination failed because the probe was too large to be pushed down between the spinous processes and the wound retractor to the operative site. Intraoperative sonography can be used easily as a routine method for exploration of the spinal canal. Technical innovations in the probes would make the method even more feasible.

To evaluate the clinical value of 3-D-reformations with and without electronic disarticulation of calcaneal fractures compared to axial CT and sagittal reformations. 25 patients with intra-articular calcaneal fractures underwent diagnostic CT-examinations. Axial slices, sagittal and 3-D-reformations with and without electronic disarticulation were performed. The sagittal and both types of 3-D-reformations were compared to the axial slices with regard to the diagnostic criteria: involvement of articular facets, number of fragments, and traumatic changes of the hindfoot. The best proof of involvement of articular facets is found in axial slices and 3-D-reconstructions after disarticulation followed by sagittal reconstructions. Usually on 3-D-reconstructions without disarticulation articular facets cannot be identified because of overlapping bones. The number of fragments is clearly demonstrated by axial slices and sagittal reconstructions followed by 3-D-reconstructions after disarticulation. Traumatic changes of the hindfoot can be diagnosed in all four forms of visualisation. The decisive diagnosis for treatment planning is made based on the axial slices supported by sagittal reformations. In unclarified cases 3-D-reformations after electronic disarticulation may provide further information. 3-D-reformations without disarticulation are useless.