Computed Tomography-Derived Occipital–Coccygeal Length and Ilium Wing Distance Correlates with Skin to Epidural and Intrathecal Depths in Dogs

Abstract

The current clinical techniques for neuraxial needle placement in dogs are predominantly blind without prior knowledge of the depth required to reach the desired space. This study investigated the correlation and defined the relationship between easily obtainable external landmark variables in the dog; occipital–coccygeal length (OCL) and ilium wings distance (IWD), with the skin to epidural and intrathecal space distances using computed tomography (CT). The CT images of 86 dogs of different breeds were examined in this retrospective observational study. Images of dogs in sternal recumbency were optimized to the sagittal view. The distances between the skin and lumbosacral epidural space (LSE) and skin to sacrococcygeal space (SCE) were measured to the ligamentum flavum surrogate (LFS) line. The distance between the skin and the intrathecal space (ITS) was measured from the skin to the vertebral canal at the interlumbar (L5–L6) space. Measurements of the IWD and OCL were performed on dorsal and scout views, respectively. Linear regression equations and Pearson’s correlation coefficients were calculated between variables. Data were reported as mean (standard deviation). Significance was set as alpha < 0.05. After exclusion of four dogs, 82 CT scans were included. The depths were LSE 45 (15) mm, SCE 23 (10) mm, and ITS 50 (15) mm. There was a moderate correlation between OCL with LSE (=14.2 + OCL * 0.05 (r = 0.59, p < 0.0001)), and a strong correlation with ITS (=11.4 + OCL * 0.07 (r = 0.76, p < 0.0001)), while a very weak correlation was found with SCE (=14.0 + OCL * 0.02 (r = 0.27, p < 0.0584)). Similarly, with IWD, there was a moderate correlation with LSE (=10.8 + IWD * 0.56 (r = 0.61, p < 0.0001)), and strong correlation with ITS (=9.2 + IWD * 0.67 (r = 0.75, p < 0.0001)), while a weak correlation was found with SCE (=11.2 + IWD * 0.2 (r = 0.32, p < 0.0033)). Mathematical formulae derived from the multiple regression showed that the body condition score (BCS) improved the relationship between IWD and OCL and the LSE, SCE and ITS, while the addition of body weight was associated with multicollinearity. Further studies are required to determine the accuracy of the algorithms to demonstrate their ability for prediction in a clinical setting.

Mathematical Models for the Skin to Lumbosacral Epidural Distance in Dogs: A Cadaveric Computed-Tomography Study

“…The cadavers were placed in sternal recumbency in the gantry of the CT. In the first phase, three pelvic limb positions were used to determine the effect of positioning on the CT derived skin to lumbosacral epidural distance (CLED) [12], with the pelvic limbs extended caudally (pulled backwards), neutral (placed on the side), and extended cranially (pulled forward). Positioning of the cadavers was performed each time by the same observers (ML and TCS).…”

“…For each scan, a first straight line was drawn from the cranial margin of the dorsal lamina of the seventh lumbar vertebra to the cranial margin of the first sacral vertebra. This line was defined as the ligamentum flavum surrogate [12]. A secondary line was then drawn to the skin with an angle of 60 degrees to the middle of the first line and was defined as the CLED [12].…”

“…This line was defined as the ligamentum flavum surrogate [12]. A secondary line was then drawn to the skin with an angle of 60 degrees to the middle of the first line and was defined as the CLED [12]. Measurements to the nearest millimetre were obtained for each of the three positional scans.…”

“…The skin to lumbosacral epidural space distance has recently received similar interest in veterinary anaesthesia [10][11][12]. A recent study in 86 dogs identified significant positive correlations between external variables (occipital-coccygeal length (OCL) and ilium wing distance (IWD)), and the skin to epidural distance using computed tomography (CT) [12].…”

“…The skin to lumbosacral epidural space distance has recently received similar interest in veterinary anaesthesia [10][11][12]. A recent study in 86 dogs identified significant positive correlations between external variables (occipital-coccygeal length (OCL) and ilium wing distance (IWD)), and the skin to epidural distance using computed tomography (CT) [12]. Multiple regression analyses have also found that the addition of a dog body condition score further improved the relationship between the external variables and the skin to epidural distance.…”