Transesophageal echocardiography in the imaging of spinal cord structures – a systematic review of the literature

Mendrala, Martyna; Kosiński, Sylweriusz; Darocha, Tomasz; Podsiadło, Paweł; Czober, Tomasz; Mendrala, Konrad

doi:10.15557/jou.2025.0028

Abstract

Background

Transesophageal echocardiography enables visualization of structures within the spinal canal, particularly in the upper thoracic and lower cervical regions, but its diagnostic performance and clinical roles remain unclear.

Aim

To systematically review studies evaluating the ability of transesophageal echocardiography to depict spinal canal anatomy and its potential diagnostic, monitoring, and interventional applications.

Material and methods

A PRISMA-guided systematic review (PROSPERO CRD420251074380) was conducted to identify human studies evaluating transesophageal echocardiography for imaging spinal canal structures. PubMed/MEDLINE, Embase, and Web of Science were searched from inception to September 2025; screening and de-duplication were supported by Rayyan, and findings were synthesized narratively.

Results

Thirteen studies met the inclusion criteria. Transesophageal echocardiography consistently identified key landmarks such as the epidural space, dura mater, subarachnoid compartment, and catheter position, with the best visualization reported in the upper thoracic and lower cervical segments. Reported applications included adjunctive diagnosis of selected pathologies, intraoperative assessment of spinal perfusion, and procedural guidance. Image quality and feasibility were influenced mainly by patient habitus and anatomy. Safety signals were favorable, although systematic assessment was lacking. No study provided robust comparative accuracy versus magnetic resonance imaging or computed tomography, and standardized outcome measures were uncommon.

Conclusions

Transesophageal echocardiography shows promise for real-time visualization of spinal canal structures and select intraoperative and interventional uses. However, current evidence is limited to small, heterogeneous studies. Rigorous prospective research including standardized imaging endpoints and comparative evaluations is needed to define its diagnostic accuracy, safety, and clinical impact.

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