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

Tanaka, Kei; Irikoma, Shingo; Kokubo, Sotaro

doi:10.1016/s0034-7094(13)70224-1

Cited by 13 publications

(3 citation statements)

References 12 publications

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“…Traditional techniques, such as X-ray and ultrasound, have been investigated for the visual guidance of spinal puncture. Tanaka et al 19 found that the accuracy of puncture point location by X-ray guidance (67%) was better than that of the traditional anatomic localization approach (29-59%). However, the X-ray-guided spinal puncture technique is generally used only for patients in the prone position, while spinal anesthesia puncture requires the patient to be in the lateral decubitus or sitting position.…”

Section: Discussionmentioning

confidence: 99%

Accuracy Evaluation Trial of Mixed Reality-Guided Spinal Puncture Technology

Wu¹,

Gao²,

Qiao³

et al. 2023

TCRM

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To evaluate the accuracy of mixed reality (MR)-guided visualization technology for spinal puncture (MRsp). Methods: MRsp involved the following three steps: 1. Lumbar spine computed tomography (CT) data were obtained to reconstruct virtual 3D images, which were imported into a HoloLens (2nd gen). 2. The patented MR system quickly recognized the spatial orientation and superimposed the virtual image over the real spine in the HoloLens. 3. The operator performed the spinal puncture with structural information provided by the virtual image. A posture fixation cushion was used to keep the subjects' lateral decubitus position consistent. 12 subjects were recruited to verify the setup error and the registration error. The setup error was calculated using the first two CT scans and measuring the displacement of two location markers. The projection points of the upper edge of the L3 spinous process (L3↑), the lower edge of the L3 spinous process (L3↓), and the lower edge of the L4 spinous process (L4↓) in the virtual image were positioned and marked on the skin as the registration markers. A third CT scan was performed to determine the registration error by measuring the displacement between the three registration markers and the corresponding real spinous process edges. Results:The setup errors in the position of the cranial location marker between CT scans along the left-right (LR), anterior-posterior (AP), and superior-inferior (SI) axes of the CT bed measured 0.09 ± 0.06 cm, 0.30 ± 0.28 cm, and 0.22 ± 0.12 cm, respectively, while those of the position of the caudal location marker measured 0.08 ± 0.06 cm, 0.29 ± 0.18 cm, and 0.18 ± 0.10 cm, respectively. The registration errors between the three registration markers and the subject's real L3↑, L3↓, and L4↓ were 0.11 ± 0.09 cm, 0.15 ± 0.13 cm, and 0.13 ± 0.10 cm, respectively, in the SI direction. Conclusion: This MR-guided visualization technology for spinal puncture can accurately and quickly superimpose the reconstructed 3D CT images over a real human spine.

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Section: Discussionmentioning

confidence: 99%

Accuracy Evaluation Trial of Mixed Reality-Guided Spinal Puncture Technology

Wu¹,

Gao²,

Qiao³

et al. 2023

TCRM

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“…Palpation may not be a reliable technique, with an error of one-third to identify the interspinous level in obstetric patients. 2 It seems to be safer for anesthesiologists to aim at L3-L4 interspinous level or lower in the intrathecal technique. The intervertebral needle insertion site that is usually targeted is the L3-L4 interspace, or less commonly, the L2-L3 interspace.…”

Section: Discussionmentioning

confidence: 99%

Foot Drop after Combined Spinal Epidural: A Rare Neurological Complication

Patil¹,

Tiwari²,

Mathkar³

et al. 2019

Journal of Research &Amp; Innovation in Anesthesia

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Neurological deficit post central neuraxial blockade is rare but considered for highest compensation. We present a case of S1 mononeuropathy presented as foot drop after combined spinal epidural. A 30-years-old male with lower limb fracture was posted for plating. Patient was ASA grade I and all his investigations were normal. Combined spinal epidural was planned. The procedure was performed following all standard operating procedures. Surgical procedure was uneventful, epidural catheter was removed 12 hours postoperatively. 24 hours postoperatively foot drop was noted. Patient was evaluated by neurologist. Ankle dorsiflexion power-1/5, extensor hallucis longus and extensor digitorum brevis were weak. MRI spine was done, which was normal. Neurologic impairment after subarachnoid block is rare, but multifactorial. The causes can be divided into iatrogenic or idiopathic. In some cases it could be a coincident to clinical presentation of any other organic disease. Trauma by the needle or catheter are the commonest causes for the neurological deficit. Regular follow-up and supportive treatment is important in these patients. Medicolegal issues is a big worry in such cases.

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“…This might be caused by inadequate difference in lumbar vertebrae furtherance in both groups (15, 16). Many studies have found landmark identification to be one of the important factors for successful spinal anesthesia administration, although its accuracy in evaluating the required intervertebral gaps is poor (1, 4, 9, 25, 26). …”

Section: Discussionmentioning

confidence: 99%

Comparison of Successful Spinal Needle Placement Between Crossed-Leg Sitting Position and Traditional Sitting Position in Patients Undergoing Urology Surgery

2016

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BackgroundThe patient’s position during spinal anesthesia administration plays a major role in the success of spinal needle insertion into the subarachnoid space. The traditional sitting position (TSP) is the standard position for spinal anesthesia administration, but the success rate for spinal anesthesia administration in the TSP is still quite low. The crossed-leg sitting position (CLSP) is one of the alternative positions for the administration of spinal anesthesia, which can increase the degree of lumbar flexion.ObjectivesThis study aimed to compare successful spinal needle placement to patients in the CLSP and patients in the TSP prior to undergoing urology surgery.MethodsThis study was a non-blinded, randomized controlled trial in patients undergoing spinal anesthesia for urologic procedures from March-October, 2015 in the central national hospital Dr. Cipto Mangunkusumo, Indonesia. After obtaining approval from the FMUI – RSCM (Faculty of Medicine Universitas Indonesia – Rumah Sakit Dr. Cipto Mangunkusumo) Ethical Committee and informed consent from patients, 211 subjects were allocated into two groups: the CLSP group (n = 105) and the TSP group (n = 106). The proportion of successful spinal needle placement to the subarachnoid space, ease of landmark palpation, and the number of needle-bone contacts in both groups were then assessed and analyzed.ResultsThe rate of first-time successful spinal needle insertion was not significantly different between the CLSP and TSP groups (62.9% versus 55.7%, P > 0.05). Ease of landmark palpation in the CLSP group was not significantly different from that in the TSP group (86.7% versus 76.4%, P > 0.05). The number of needle-bone contacts in both groups were not significantly different (P > 0.05). The complication rates were similar in both groups.ConclusionsThe rate of successful spinal needle placement in the CLSP group was not significantly different from that in the TSP group in patients undergoing urology surgery. The CLSP can be used as an alternative sitting position for administration of spinal anesthesia.

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

Abstract: 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.

Cited by 13 publications

References 12 publications

Accuracy Evaluation Trial of Mixed Reality-Guided Spinal Puncture Technology

Accuracy Evaluation Trial of Mixed Reality-Guided Spinal Puncture Technology

Foot Drop after Combined Spinal Epidural: A Rare Neurological Complication

Comparison of Successful Spinal Needle Placement Between Crossed-Leg Sitting Position and Traditional Sitting Position in Patients Undergoing Urology Surgery

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