Identification of the Lumbar Interspinous Spaces: Palpation Versus Ultrasound

Abstract

There was poor agreement between palpation and ultrasound estimation of the specific lumbar interspace, and when there was disagreement, the ultrasound estimate was more often higher than the palpitation estimate.

Identification of cervicothoracic intervertebral spaces by surface landmarks and ultrasound

“…2 Moreover, for the lumbar vertebral region, it has been shown that clinicians are more likely to select interspaces that are one or two spaces higher than the correct space. 2,20 When trying to identify the T7-8 interspace in our study, the surface landmark method was more likely to indicate a more caudal interspace than ultrasonography. When using chest radiography as a gold standard for the thoracic spine, the inaccuracy has been to identify lower interspaces.…”

Teaching sonoanatomy to anesthesia faculty and residents: utility of hands-on gel phantom and instructional video training models

“…This localization process may be problematic when patients are obese, pregnant, or have spinal abnormalities, including misalignment or degenerative changes [3][4][5][6][7]. Ultrasound can be used to gain a more accurate understanding of a patient's spinal anatomy, leading to fewer needle insertion attempts and spinal needle manipulations, and improve patient satisfaction [3,5,6,[8][9][10][11][12][13][14][15][16][17][18]. Further, a decrease in the number of needle insertion attempts has been shown to correlate with a decreased incidence of postdural puncture headache [19], new-onset persistent low-back pain [20], and puncture site bleeding [21].…”

Usefulness of a pre-procedure ultrasound scanning of the lumbar spine before epidural injection in patients with a presumed difficult puncture: A randomized controlled trial

“…These studies have reported a strong relationship between the epidural space depth measured by US and the insertion depth of the needle, confirmed more recently by other authors [6,7]. US can also help to identify the interspinous spaces where palpation has been shown to be frequently inaccurate [8]. Pre-procedure US scanning of the lumbar spine is currently widely used to help perform epidural anesthesia or lumbar puncture [9][10][11].…”

“…However, in patients with easily palpable anatomical landmarks, the use of pre-procedural spinal ultrasound did not improve the ease of insertion of labour epidural catheters as compared with the traditional palpation technique [28]. Finally, in 120 orthopedic patients undergoing lower limb surgery, US was associated with both a significantly higher number of successful epidural puncture on the first needle insertion attempt (65% vs. 32%) and a significantly smaller number of needle passes (6 [1][2][3][4][5][6][7][8][9][10] vs. 13 [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]) [19]. In our study, number of redirections and number of injections performed in a single attempt were not different between the two groups, which probably explain why we did not find any difference in VAS pain.…”

“…After randomization, patients remained blinded to their group allocation. Patients of the US group underwent a prepuncture examination of the lumbar spine by two experimented operators (CDL and BLG) using an ESAOTE MyLab 70x Vision with a linear ultrasound probe (3)(4)(5)(6)(7)(8)(9)(10)(11). In order to have a wider field of view, we used the trapezoid mode of our probe.…”