• Chang Jiang, Yiwei Xiang, Zhiyang Zhang, Yuanwu Cao, Nixi Xu, Yinglun Chen, Jiaqi Yao, Xiaoxing Jiang, Fang Ding, Rui Zheng, and Zixian Chen.
• Department of Orthopaedics, Zhongshan Hospital Fudan University, Shanghai, China.
• Spine. 2024 Nov 15; 49 (22): E378E384E378-E384.

Study DesignPreclinical experimental study.ObjectiveTo develop an intraoperative ultrasound-assisted imaging device, which could be placed at the surgical site through an endoscopic working channel and which could help surgeons recognition of different tissue types during endoscopic spinal surgery (ESS).Summary Of Background DataESS remains a challenging task for spinal surgeons. Great proficiency and experience are needed to perform procedures such as intervertebral discectomy and neural decompression within a narrow channel. The limited surgical view poses a risk of damaging important structures, such as nerve roots.MethodsWe constructed a spinal endoscopic ultrasound system, using a 4-mm custom ultrasound probe, which can be easily inserted through the ESS working channel, allowing up to 10 mm depth detection. This system was applied to ovine lumbar spine samples to obtain ultrasound images. Subsequently, we proposed a 2-stage classification algorithm, based on a pretrained DenseNet architecture for automated tissue recognition. The recognition algorithm was evaluated for accuracy and consistency.ResultsThe probe can be easily used in the ESS working channel and produces clear and characteristic ultrasound images. We collected 367 images for training and testing of the recognition algorithm, including images of the spinal cord, nucleus pulposus, adipose tissue, bone, annulus fibrosis, and nerve roots. The algorithm achieved over 90% accuracy in recognizing all types of tissues with a Kappa value of 0.875. The recognition times were under 0.1 s using the current configuration.ConclusionOur system was able to be used in existing ESS working channels and identify at-risk spinal structures in vitro. The trained algorithms could identify 6 intraspinal tissue types accurately and quickly. The concept and innovative application of intraoperative ultrasound in ESS may shorten the learning curve of ESS and improve surgical efficiency and safety.Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.

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