Lumbar puncture needle length determination

Abe, Keith; Yamamoto, Loren G.; Itoman, Erick M.; Nakasone, Terri A.F.; Kanayama, Stacy K.

doi:10.1016/j.ajem.2005.03.012

Cited by 26 publications

(24 citation statements)

References 3 publications

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“…We believe our formula more accurately predicted the SCD length than the formula of Abe et al, 10 because the BMI in the cohort of 50 patients from which we derived our formula is more reflective of the adult US population. The patient population in the Abe et al study had a BMI of 22.6 (BMIC, normal) and included children and adults, while the BMI in our cohort of adult patients was 31.7 (BMIC, obese), which is more similar to the average BMI of 28.4 (BMIC, overweight) seen in the adult US population.…”

Section: Discussionmentioning

confidence: 71%

“…Our formula would have predicted the correct needle length in 14/15 (93%) female patients and selection of a needle that was too long (5 versus 3.5 inch) in 1 patient; while in men, our formula predicted the correct needle in 25/30 (83%) patients and selection of a needle that was too long (5 versus 3.5 inch) in 5 male patients. There have been studies that have derived formulas to estimate SCD for interspinous approach LPs, including the formulas by Abe et al, 10 Ma et al, 11 Stoker and Bonsu, 12 , and Chong et al, 13 which are often cited in the literature. The SCD that all 4 formulas predicted were significantly different from the actual SCD (all, P Ͻ .001) measured in our cohort of 45 patients.…”

Section: Discussionmentioning

confidence: 99%

“…9 Formulas to determine proper needle length in non-fluoroscopy-guided interspinous lumbar punctures have been investigated [10][11][12][13] ; however, there is no established method to determine the appropriate needle length for OIA-FGLPs. The purpose of this study is to determine whether BMI could help predict the appropriate needle length in OIA-FGLPs.…”

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confidence: 99%

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Using Body Mass Index to Predict Needle Length in Fluoroscopy-Guided Lumbar Punctures

Nayate

Nasrallah

Schmitt

et al. 2015

AJNR Am J Neuroradiol

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Using Body Mass Index to Predict Needle Length in Fluoroscopy-Guided Lumbar Punctures

Nayate

Nasrallah

Schmitt

et al. 2015

AJNR Am J Neuroradiol

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“…Many factors associated with neuraxial anaesthesia have been studied including the structures at the level of the termination of the spinal cord and dural sac [11], vertebral level and shape of the conus medullaris [12], shape of the epidural space [13][14][15], and distance from the skin to the epidural or subarachnoid spaces [16][17][18][19]. However, the effect of body position relevant to neuraxial blockade has not been well studied [20][21][22][23][24], especially in children.…”

Section: Discussionmentioning

confidence: 99%

The effect of flexion on the level of termination of the dural sac in paediatric patients

et al. 2009

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SummaryAlthough the anatomy of the spinal cord and its associated structures have been well defined, the effects of body position relevant to neuraxial blockade have not been elucidated. This study was designed to determine the effect of body position on the end of the dural sac in children. After induction of anaesthesia, ultrasound examination was performed to evaluate the location of the dural sac end in the lateral position with a straight back and knee, and in the lateral position with the knees, legs, and neck flexed. The level of the end of the dural sac was determined in relation to the vertebrae. Our data demonstrate that the dural sac shifts significantly cephalad in the lateral flexed position used for neuraxial blockade (p < 0.001). These results suggest that the safety margin to avoid dural puncture during hiatal or S2-3 approach for caudal block can be increased in younger children. Dural puncture is a serious technical complication during single-shot caudal block, which is the most common regional technique for postoperative analgesia for paediatric subumbilical surgery. The prevalence of dural puncture associated with caudal analgesia is relatively low. It has only been shown in several case reports [1,2] or at a rate of 1.2% in previous large-scale studies [3,4]. In the study of 760 children, Busoni did not find any case of dural puncture and Dalens [5] reported only one dural puncture in his series of 750 paediatric caudals. Sometimes it is difficult to identify the sacral hiatus and the caudal space due to variations of anatomical structures or obesity. In these cases, a trans-sacral approach to caudal block, described by Busoni [6], may be used as an alternative method. Although no dural puncture was reported in several trans-sacral approach studies [6][7][8], the risk of dural puncture is a possibility. It is known that the end of the dural sac is located at the S4 level just after birth, then ascends to the S2 level as the child grows [9].The anatomy of the spinal cord and its associated structures have been well defined [10], largely based on post-mortem or imaging studies in the supine or prone positions. Many factors associated with neuraxial anaesthesia have been studied including the structures at the level of the termination of the spinal cord and dural sac [11], vertebral level and shape of the conus medullaris [12], shape of the epidural space [13][14][15], and distance from the skin to the epidural or subarachnoid spaces [16][17][18][19]. However, the effect of body position relevant to neuraxial blockade has not been well studied [20][21][22][23][24], especially in children.Ultrasonography, which is a well-established method of investigating the spinal canal, spinal cord, and meningeal coverings in infants and children, has the advantage of being real time, non invasive and safe [25][26][27]. It allows detection of congenital malformations such as myelocele, myelomeningocele, spinal lipoma, dorsal dermal sinus, tight filum terminale syndrome, diastematomyelia, hydromyelia and syri...

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“…SCD has also been estimated retrospectively by measuring image datasets from patients who had undergone abdominal CT 10. However, fewer than 10 of these patients were infants and, additionally, the patients were lying supine.…”

Section: Discussionmentioning

confidence: 99%