Identification of the Lumbar Interspinous Spaces by Palpation and Verified by X-rays

Abstract

Background and objectives: Palpation has been shown to be rather inaccurate at identifying lumbar interspinous spaces in neuraxial anesthesia. The aim of this study is to assess the accuracy of the determination of the lumbar interspinous spaces by anesthesiologist's palpation using post-operative X-rays in obstetric patients. Methods: We reviewed the anesthetic record and the post-operative abdominal X-rays of the cesarean sections. We indwelled the epidural catheter for post-operative one-shot analgesia. We included combined spinal and epidural anesthesia cases and compared the interspinous level which the anesthesiologist recorded and the epidural catheter insertion level confi rmed by abdominal X-ray for each case. We also evaluated the factors (age, body weight, height, Body Mass Index, gestational age, and the type of surgery [planned / emergency]) leading to misidentifi cation of interspinous level. Results: Nine hundred and sixty seven cesarean sections were performed and a total of 835 cases were evaluated. The levels of the puncture documented by the anesthesiologists were in agreement with the actual catheter insertion levels in 563 (67%) cases. When the anesthesiologists aimed at L2-3 level, we found the catheter insertion at L1-2 in 5 cases (4.9%), none of which had any post-operative neurological defi cits. No variables evaluated were signifi cantly associated with misidentifi cation of interspinous level by the anesthesiologists. Conclusions: There was a discrepancy between the anesthesiologists' estimation by palpation and the actual catheter insertion level shown in X-rays. It seems to be safer to choose the interspinous level L3-4 or lower in spinal anesthesia.

Abdominal circumference but not the degree of lumbar flexion affects the accuracy of lumbar interspace identification by Tuffier’s line palpation method: an observational study

“…The safety of subarachnoid puncture rests in accurately identifying the desired predetermined level for administering the anesthetic, so as to avoid the potentially disastrous complication of mechanical spinal cord injury [ 1 , 2 ]. Spinal anesthesia is generally performed by the palpation of various bony landmarks, although this method yields accurate identification of the vertebral level in only 29% to 69% of cases [ 3 – 5 ]. Furthermore, this method is fraught with controversy as to the exact location of specific anatomical landmarks [ 4 , 6 ].…”

Prediksi Kesulitan Penempatan Jarum Spinal Berdasarkan Gambaran Radiologis dan Penanda Anatomis pada Pasien Bedah Urologi

“…Data ini dapat digunakan pada penelitian ini karena terdapat kesamaan karakteristik tulang belakang pada sesama ras Asia. 22 Pada penelitian ini kualitas penanda anatomis tulang belakang memiliki hubungan yang bermakna dengan kesulitan penempatan jarum spinal (p<0,001). Hasil ini sesuai dengan hasil penelitian sebelumnya yang menyebutkan bahwa kualitas penanda anatomis berkaitan dengan keberhasilan anestesi spinal pada penyuntikan pertama.…”

The Accuracy of Locating Lumbar Vertebrae When Using Palpation Versus Ultrasonography

“…The accuracy of any single technique, including the iliac crest technique described above, ranged from 45% to 61%. 7 Other studies 11,12 have shown that the magnitude of the error from palpation may be so great that different spinal levels were identified when compared with a radiologic standard. 6 Despite these known difficulties, identifying spinal landmarks by palpation remains an integral part of clinical practice.…”