Accuracy of manual palpation vs ultrasound for identifying the L₃–L₄ intervertebral space level in children

Abstract

This observational study found no difference in the accuracy of landmark palpation, when performed by a consultant anesthesiologist, and ultrasound for determining the L3-L4 intervertebral space in children.

Residency Training: A failed lumbar puncture is more about obesity than lack of ability

“…In the study mentioned earlier linking BMI with landmark identification, US guidance allowed their identification in all obese patients, 3 and others showed its benefit when performing LPs in different settings. [7][8][9] The added costs of fluoroscopy and US guidance over the standard procedure seem comparable. 10 The benefits, risks, and cost of stratifying morbidly obese patients to an initial USassisted LP in the clinic should be prospectively evaluated.…”

Ultrasonography is more accurate than percutaneous palpation for identifying targeted thoracolumbar intervertebral disc spaces in dogs

“…To our knowledge, the accuracy rates for identifying a targeted thoracolumbar intervertebral disc space by percutaneous palpation or ultrasound have not yet been reported in the veterinary literature. The largest human studies report an accuracy of 29% for manual palpation and accuracies between 71% and 77% for ultrasound . Based on these values, the sample size calculation with a confidence level of 95% and a power of 85% yielded a sample size between 15 and 21.…”

“…The use of ultrasound for intervertebral disc space localization to perform an epidural injection has also been reported in several veterinary studies . Data from available human literature demonstrate that, in many cases, intervertebral disc space identification using percutaneous palpation based on anatomical landmarks differs from that obtained by ultrasound‐guided identification in 36–64% of cases and that ultrasound is more precise, with an accuracy of 71–77% . An ultrasound guidance technique is not intended at replacing a fixed radiographic marker, which will remain the standard in most cases.…”

Ultrasonography helps emergency physician identify the best lumbar puncture site under the conus medullaris

“…There is increasing evidence for the benefits of ultrasound-assisted lumbar puncture, particularly in children and infants [2, 3]. The main benefit of ultrasound localization of puncture site is the easy identification of traditional anatomical landmarks [4, 5]. In fact, anatomical assessment of intervertebral space level for lumbar puncture is misleading in more than 36% [6].…”