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Glendale Adventist Medical Center
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Glendale, CA 91206
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MRI in the Operating Room: Seeing Is Believing, But Is It Worth the Effort?

Posted on: 11/30/1999
Surgeons commonly use X-rays, ultrasound, and other imaging tests before and after spine surgery. These tests help them pinpoint the exact areas for the procedure and assess whether a procedure has been properly completed.

Intraoperative magnetic resonance imaging (IMRI) actually allows the surgical team to get MRI scans during surgery. IMRI technology has been used in neurosurgery for some time. The surgeons in this study used IMRI during 12 spine surgeries. The hope was that IMRI technology could improve the accuracy of surgical techniques by giving the surgeons updated images during the procedures.

All 12 surgeries were completed successfully, with no major complications. The authors report that the IMRI helped with surgical planning and locating. It also helped them verify the relief of pressure from the nerve roots in 10 of the 12 patients.

Using the IMRI has some disadvantages. The surgeries took somewhat longer than usual, which was partly due to the surgical team dealing with a new system and new equipment. In two of the patients, the IMRI was not helpful in confirming if pressure had been relieved around the spinal nerve roots, meaning that surgeons will need to continue to rely on their surgical knowledge and experience. Also, MRI scans don't show bone as clearly as soft tissues, which may make it less helpful for some types of spine surgery.

One of the biggest limiting factors in using IMRIs may well be the expense. The start-up costs are significant, and it also requires using special operating room instruments that don't interfere with the magnetic field of the machine. The high expenses means that doctors and hospitals will need to decide just how helpful the IMRI really is for spine surgery. Do most spine surgeries really require more precise imaging during surgery? As another doctor writes in a commentary on this article, "We must all ensure that we do not encourage the triumph of technology over reason."

References:
Eric J. Woodard, MD, et al. Initial Experience With Intraoperative Magnetic Resonance Imaging in Spine Surgery. In Spine. February 15, 2001. Vol. 26. No. 4. Pp. 410-417.

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