Influence of age, laterality, patient position, and spinal level on the interlamina space for spinal puncture

Abstract

Background and objectivesThe lumbar interlamina space height is an important determinant of successful spinal puncture. We aimed to evaluate the influence of age, laterality, patient position, and spinal level on the height of the interlamina window using ultrasonography.MethodsUltrasonographic examination was performed in 20 adult patients aged under 40 years (group Y) and 20 patients aged over 60 years (group O). We set three primary outcomes: difference in the interlamina height of the ligamentum flavum-dura mater complex (LFD) according to (1) age, (2) laterality, and (3) position. For secondary outcomes, the degree of ultrasonography visualization (poor, intermediate, or good) and the depths from the skin to LFD and to anterior complex were also measured on right and left paramedian sagittal oblique view in both lateral and sitting positions at L3/4, L4/5, and L5/S1 levels. All variables were analyzed in association with age, laterality, patient position, and spinal level.ResultsThe interlamina height of LFD was higher, and the degree of visualization was better in group Y than in group O. It differed depending on laterality in paramedian sagittal oblique view images in the same patients at all spinal levels. The interlamina height of LFD was the largest at L5/S1 level in both groups. Position had little influence on the interlamina height of LFD.ConclusionsScanning both sides and all spinal levels before selecting a puncture site for ultrasound-guided spinal anesthesia is recommended. The L5/S1 spinal level is a good option for spinal puncture in the elderly.Trial registration numberNCT03929874.

Optimal angle of needle insertion for spinal anesthesia in patients with spondylolisthesis: an ultrasonographic study

“…There have been many studies on anatomical considerations that facilitate spinal anesthesia in patients with lumbar spinal deformities; these studies have used imaging modalities such as computed tomography (CT), magnetic resonance imaging (MRI), and ultrasonography [11,15]. Among these modalities, ultrasonography has proved its usefulness in visualizing the interlaminar space especially in patients with abnormal spinal anatomy [4,[16][17][18].…”

“…Total of 40 participants, 20 patients with singlelevel spondylolisthesis (group S) and 20 patients with normal spinal anatomy (group N) were recruited. The sample size was set empirically by referring to previous studies comparing the distance on ultrasound images [11][12][13]. Lumbosacral spinal X-ray image were taken in all patients scheduled for surgery under spinal anesthesia for preoperative evaluation.…”

“…The ultrasonography image in the paramedian sagittal oblique view was obtained on the dependent side by placing the ultrasound probe lateral to the midline and tilting it medially. The level of each interlaminar space was confirmed by counting up from the sacrum [11]. The expected optimal needle insertion angle was measured using the same method that was used for the transverse midline view (Fig.…”

Ultrasonography for lumbar neuraxial block

“…Scanning both sides and all spinal levels before selecting a puncture site for US-guided spinal anesthesia is recommended. The L5-S1 intervertebral level is a good option for neuraxial anesthesia in the elderly [ 42 ].…”