Correlation between spinous process dimensions and ease of spinal anaesthesia

Abstract

Background:Neuraxial anaesthesia, despite being a common technique, may pose some technical challenges leading to complications such as post-dural puncture headache, trauma to neural structures and neuraxial haematoma. We hypothesised that the interspinous gap (ISG) and the spinous process width (SPW) could be used as objective measures to predict ease of access to the neuraxial space.Methods:Two hundred and two consecutive patients scheduled to have spinal anaesthesia for various surgical procedures were enrolled prospectively after institutional approval. Following proper positioning for the neuraxial blockade, the ISG and SPW at the intended level were measured with calipers. The number of attempts, and redirections at the selected spinal level, and the number of levels required for successful needle placement were also recorded.Results:Group-wise analysis of the data into patients requiring >1 attempt, >1 level and ≥3 redirections showed that the single independent predictor of a difficult neuraxial block was the ISG. Twenty-three percent of the patients required more than one attempt, with a mean gap of 6.35 (±1.2) mm, in contrast to 8.15 (±2.4) mm in those with a single attempt (P=0.000). In addition, 16% of the patients needed more than one level, with a mean gap of 6.03 (±2.01) mm in contrast to 8.07 (±2.37) mm for a single level (P=0.000).Conclusions:The single independent predictor of ease or difficulty during spinal anaesthesia was the ISG (P=0.000).

A study on the ease of placement of spinal needle in relation to height, weight and BMI in a geriatric population of Eastern India

“…Moreover, a greater body weight contributes to difficult needle placement due to more body fat, less flexibility and less prominent bony landmarks. Therefore, this explains the similar findings in both the present study and that of Shankar H et al 9 Thus, it is observed that BMI is the main determinant for the ease of placement of spinal needle in most studies. It can also be understood that a lesser height and greater weight leading to greater BMI is an impediment to easy lumbar puncture.…”

“…The depth to the neuraxial space and BMI was shown to be a predictor of success, along with the practitioner's experience in a more recent study by Kim JH et al, Shankar H et al, could not calculate BMI in all subjects due to missing height data in 119 subjects. 8,9 Chien et al, reported that age and gender were not associated with the first-level success or first attempt success. 10 Ravi KK et al, found that as the weight of the patients increased, the depth of the epidural space also increased.…”

“…It was also more in patients with lesser mean height, greater mean weight and greater mean BMI and these were non-significant. Body habitus and spinal anatomy have been shown to be predictors of success 7,9 . Mathematically a combination of greater height and lesser weight leads to a lower BMI.…”

Comparison Between Pendant Position and Traditional Sitting Position for Successful Spinal Puncture in Spinal Anesthesia for Cesarean Section

“…Grau et al mentioned that the mean of intervertebral spaces for pregnant females was 10.7 mm, while in non-pregnant females it was 11.6 mm (P value < 0.006) ( 9 ). However, no study mentioned the size of intervertebral spaces among Indonesian population ( 10 , 11 ).…”

Effect of Position During Spinal Anesthesia on Postdural Puncture Headache After Cesarean Section: A Prospective, Single-Blind Randomized Clinical Trial

“…Similar to other neuraxial techniques, spinal anesthesia has some technical complications, such as postdural puncture headache (PDPH), hematoma, and damage to neural structures (6). …”