Poster Presentation 50th International Society for the Study of the Lumbar Spine Annual Meeting 2024
ULTRASOUND ASSESSMENT OF THE ANTERIOR NECK AND HEMATOMA BEFORE AND AFTER ANTERIOR CERVICAL SPINE SURGERY (#10)
Introduction: With increasing outpatient ACS, assessment of postoperative hematoma and soft-tissue swelling is crucial. Though MRI is the current standard, US has shown efficacy in evaluating fluid collections and soft tissue. Here, we aimed to assess US reliability in evaluating hematoma and neck structures pre- and post-ACS and develop a range of baseline soft-tissue changes.
Methods: Patients scheduled for 1-3 level ACDF and/or CDR without drain placement were recruited. Preoperatively and POD1, patients obtained a neck US and cervical radiograph. An orthopaedic resident and a radiology resident evaluated the US for hematoma and longus colli dimensions. Radiographs were evaluated for C2-7 retropharyngeal soft-tissue swelling. A ‘gold standard’ attending radiologist evaluated the US for hematoma presence. Interrater reliability measured by ICC was calculated for all measurements.
Results: From 2019-22, 45 patients were enrolled. Mean age was 50.9±10.9 years with 53.3% females. Nineteen patients underwent 1-level and 25 underwent 2-level procedures. One patient had a 2-level CDR and 1-level ACDF. Thirteen (28.9%) hematomas were observed on POD1 US; none were clinically significant. There were significant differences in longus colli thickness pre- and postoperatively, and a range of baseline soft-tissue changes was established (Table). The ICC was 0.685 (good reliability) for hematoma visualization and 0.970 (excellent) for hematoma long axis measurement. Between the trainees and attending radiologist, the ICC was 0.921 (excellent) for hematoma visualization and 0.867 (good) for hematoma long axis measurement. No significant differences were found between the mean hematoma measurements of all three evaluators.
Discussion: Even for a non-radiologist trainee, US appears to be an effective method to evaluate hematoma and soft tissue structures in the neck pre- and post-ACS, with good to excellent interobserver reliability.
