Abstract Details

Title Case Report: B mode ultrasound images of the thoracic spine

Topic Neuro Trauma, Critical Care, and Sports Neurology

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 4-026

Objective

Ultrasound provides the clinician an additional decision-making tool when used at the point-of-care. In the hands of a skilled user, most bodily structures can be visualized distinctly with minimal risk to the patient. Ultrasound is used in the operative room to visualize neuro-anatomy to help in operative-decision making when image guidance is not available or feasible. We present a unique case showing the ultrasound appearance of spine captured by imaging the spinal cord of a post thoracic laminectomy patient

Background

Design/Methods Case: 84-year-old male with extensive medical history presented with one week of worsening back pain with symptoms suggestive of claudication. CT in ED revealed previously known T9 and T10 compression fracture. Labs on admission were remarkable for leukocytosis to 17x10*3/uL and c-reactive protein to 257.3 MG/L. Neurosurgery recommended T8 vertebroplasty and T9 kyphoplasty and thoracic and lumbar MRI. On hospital day #3, MRI was concerning for discitis and osteomyelitis with paraspinous and epidural abscesses with advanced canal stenosis and cord compression resulting in cord edema. Blood cultures also returned positive for Staphylococcus Aureus. On hospital day #4, patient experienced worsening bilateral lower extremity weakness. The patient was emergently taken to the OR for posterior spinal fusion from T5 to T12 with laminectomy with facetectomy and evacuation of epidural abscess. His postoperative course was complicated by pericarditis and acute lower extremity DVT and was discharged to subacute rehab on post-operative day #16.

Results

Conclusions During the patient’s recovery we were allowed the unique opportunity to perform serial spinal ultrasound with unobstructed views of the spinal cord due to the removal of the vertebral lamina. We present these images as proof of the further use of point-of-care ultrasound as a tool to examine the epidural space for any residual collections postoperatively and minimize radiation to the patient from other imaging modalities.

Authors/Disclosures
PRESENTER	No disclosure on file
Mark Frenkel	No disclosure on file
	No disclosure on file
Aarti Sarwal, MD, FAAN	Dr. Sarwal has received personal compensation in the range of $0-$499 for serving as a Consultant for Stimdia, Inc. Dr. Sarwal has received personal compensation in the range of $0-$499 for serving as a Consultant for Sheinkei. Dr. Sarwal has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Society of Critical Care Medicine . Dr. Sarwal has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Society of Neuroimaging . The institution of Dr. Sarwal has received research support from Butterfly, Inc. The institution of Dr. Sarwal has received research support from Bard. The institution of Dr. Sarwal has received research support from Biogen. The institution of Dr. Sarwal has received research support from Novartis. The institution of Dr. Sarwal has received research support from CVR Global. The institution of Dr. Sarwal has received research support from NIH/NIA R01 AG066910-01 . The institution of Dr. Sarwal has received research support from Image Monitoring. Dr. Sarwal has received personal compensation in the range of $500-$4,999 for serving as a Speaker/Faculty, CME courses with Society of Critical Care Medicine . Dr. Sarwal has received personal compensation in the range of $500-$4,999 for serving as a Speaker at annual congress with Intensive Care Society. Dr. Sarwal has received personal compensation in the range of $500-$4,999 for serving as a Speaker at annual congress with Indian Society of Critical Care. Dr. Sarwal has received personal compensation in the range of $500-$4,999 for serving as a speaker/Faculty for Annual meeting, travel compensation with European Society of Intensive Care Medicine. Dr. Sarwal has received personal compensation in the range of $500-$4,999 for serving as a Speaker with ISICEM. Dr. Sarwal has a non-compensated relationship as a Social Media Editor with Neurocritical Care that is relevant to AAN interests or activities. Dr. Sarwal has a non-compensated relationship as a Secretary with American Society of Neuroimaging that is relevant to AAN interests or activities. Dr. Sarwal has a non-compensated relationship as a President with Association of Indian Neurologists in America that is relevant to AAN interests or activities. Dr. Sarwal has a non-compensated relationship as a Member, Board of Directors with Neurocritical Care Society that is relevant to AAN interests or activities. Dr. Sarwal has a non-compensated relationship as a Section Chair, Neurosciences Section with Society of Critical Care Medicine that is relevant to AAN interests or activities.

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