Intraoperative elastography and spinal surgery: a systematic review of current and future applications in clinical and preclinical models

TL;DR

This review explores how ultrasound elastography can assess spinal tissue stiffness in real time, offering new diagnostic and surgical advantages over traditional imaging.

Contribution

The paper systematically reviews the emerging use of ultrasound elastography in spinal applications, highlighting its potential for clinical and preclinical use.

Findings

Ultrasound elastography can quantify tension relief in tethered cord syndrome.

Spinal tumors can be differentiated from healthy tissue using stiffness values.

Shear wave elastography outperforms strain elastography for spinal applications.

Abstract

While conventional imaging provides excellent structural detail of the spine, it cannot assess the mechanical properties of spinal tissue in real time. Ultrasound elastography (USE) is an emerging modality that quantifies tissue stiffness, offering a potential solution to this diagnostic gap. This review synthesizes the current evidence for the use of USE in spinal pathology.

A systematic review of the PubMed, Cochrane, and Web of Science databases was conducted in accordance with PRISMA guidelines, yielding seven primary studies, three clinical and four preclinical, published between 2015 and 2024. These studies, comprising preclinical and clinical data, demonstrate USE's ability to provide real-time, quantitative feedback. Key applications identified include quantifying tension relief in tethered cord syndrome, differentiating spinal tumors from healthy tissue based on stiffness values, and assessing the biomechanical severity of acute and chronic spinal cord injury. Shear wave elastography (SWE) was the predominant modality, proving superior to strain elastography (SE) for spinal applications.

USE is a powerful adjunct to traditional spinal imaging, providing unique functional data that can enhance intraoperative surgical precision and decision-making. While challenges such as depth penetration and operator standardization remain, continued research and technological innovation position USE to significantly improve diagnostic accuracy and surgical outcomes in spinal disease management.

The online version contains supplementary material available at 10.1186/s13089-025-00462-0.

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