The anatomy of the thoracic spinal canal investigated with magnetic resonance imaging in children aged 0 to 13 years old

Imbelloni, Luiz Eduardo; Cardoso, Bruno Basilio; Torres, Claudia Carrada; Filho, Geraldo Borges de Morais; Neto, Sylvio Valença de Lemos

doi:10.15406/jcpcr.2023.14.00512

Cited by 4 publications

(7 citation statements)

References 20 publications

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“…As this is a retrospective study, the waiver of the Free and Informed Consent Form was requested and approved. The cohort for the current study included data and MRI from children who had been included in published evaluating the distance between the dura mater and the spinal cord [10].…”

Section: A Retrospective Study Approved By the Ethics And Researchmentioning

confidence: 99%

“…Recently, our group evaluated several distances between the skin and the spinal cord in children from 0 to 13 years old, mainly showing a large space between the dura mater and the spinal cord, allowing entry of a spinal anesthesia needle or accidental perforation of the dura mater during an epidural, justifying the nonoccurrence of neurological injury, and the possibility of performing single shot thoracic spinal anesthesia in children for laparoscopic cholecystectomy and adults patients [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

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Comparison of the Skin-to-Epidural Space Distance at the three Thoracic levels in Children using Magnetic Resonance Imaging for Epidural Anesthesia

Imbelloni¹,

Cardoso²,

Torres³

2023

J Sur Anesth Res

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Background: Several ways were used to assess the distance from the skin to the epidural space, with the aim of increasing the success of the technique. MRI is the most significant technological advancement in the diagnostic examination of the pediatric spine. The aim of this study was to evaluate the distance between the skin and the epidural space through MRI at three thoracic segments in children aged 0 to 13 years. Methods: Retrospective study with 105 children aged 0 to 13 years in the supine position underwent MRI, and the 2nd, 5th, and 10th thoracic segments were measured. The following parameters were evaluated: skin and the epidural space; needle entry angle between the skin and intervertebral space; and distance corrected by an angle between skin and the epidural space. To compare the proposed data between the samples, we used the Kruskal-Wallis test. The Kruskal-Wallis rank test is a non-parametric method for testing whether samples come from the same distribution. Results: This study evaluated 60 male and 45 female children. The mean distance between Skin-EpiS was 29.27 mm at T2, 26.52 mm at T5, and 24.28 mm at T10, with a significant difference, being the greatest distance found in T2. The Skin-EpiS at T10 was shorter than the other two measurements. Regarding needle entry angle between skin and the three intervertebral spaces, the smallest angle was observed (T2=27.16º) significantly smaller than in the other two spaces (T5=38.68º, T10=39.08º). However, this difference in angle did not result in a significant difference in the distance between the skin and epidural space corrected by the entry angle in the three intervertebral spaces, being practically the same, T2=33.0 mm, T5=34.60 mm, T10=32.1 mm. Conclusion: Precise Skin-EpiS distance information can facilitate accurate needle placement in children’s epidural space and thus decrease the risk of complications. This study in children aged 0 to 13 years provided important information for performing single shots or continuous thoracic epidurals, reducing the potential for complications during its performance.

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Section: A Retrospective Study Approved By the Ethics And Researchmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of the Skin-to-Epidural Space Distance at the three Thoracic levels in Children using Magnetic Resonance Imaging for Epidural Anesthesia

Imbelloni¹,

Cardoso²,

Torres³

2023

J Sur Anesth Res

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show abstract

“…The MRI can currently be performed in different positions, facilitating the approach to the subarachnoid space and nerves. The use of MRI in adults 19 and children 20 , showed a large space between the dura mater and the spinal cord in the thoracic region, allowing the use of thoracic spinal anesthesia. An MRI is often used along with the frame to help the neurosurgeon guide a hollow needle into the tumor.…”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

Old anatomy and new anatomical concepts for single shot and continuous spinal anesthesia

Imbelloni,

Gouveia,

Neto

et al. 2023

JACCOA

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This educational article shows the anatomy studied in cadavers and the latest imaging technology for spinal anesthesia. Neuraxial anesthesia is one of the regional anesthetic options that can be done by blocking the spinal cord neural transmission through the administration of local anesthetics either via intrathecal, epidural, continuous spinal anesthesia, or combined epidural-spinal anesthesia. Several descriptions of the spinal canal anatomy have been reported since the 16th century by Leonardo da Vinci, and the use of modern radiological imaging technology has provided important insights into understanding anatomical and pathophysiological aspects implicated in spinal anesthesia. The vertebral level at which the spinal cord finishes varies widely from T12 to the L3-L4 intervertebral disc and the spinal cord extends to the L1-L2 and the L2-L3. In this educational study, cadaver anatomy and new approaches with ultrasound, magnetic resonance imaging, computed tomography, and fluoroscopy will be covered, to approach spinal and continuous spinal anesthesia. Between the medulla and any given level of the spinal cord, the fibers of the anterolateral system and posterior columns are dissociated. Despite all the new imaging studies to assist in performing subarachnoid punctures for single shot or continuous spinal anesthesia, anatomical landmarks remain the most used for both the lumbar and thoracic approaches.

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“…Studying the thoracic spine through magnetic resonance imaging (MRI) between the distance from the dura mater and spinal cord, at three levels (T2, T5, T10) in adults (in 2010) and children aged 1 to 13 years (2013) showed that there is a larger space in T5 compared to T2 and T10. 1,2 In adults, the mean posterior dural-spinal cord distance was at T2 equal to 3.9 mm, at T5 equal to 5.8 mm and at T10 equal to 4.1 mm. 1 The children's mean posterior dural-spinal cord distance at the three levels was T2 equal 4.52 mm, T5 equal 5.61 mm and T10 equal 4.68 mm.…”

Section: Introductionmentioning

confidence: 99%

“…1 The children's mean posterior dural-spinal cord distance at the three levels was T2 equal 4.52 mm, T5 equal 5.61 mm and T10 equal 4.68 mm. 2 Practically in children and adults there is an important space between the dura mater and the spinal cord to protect against causing injury during access to the subarachnoid space. These studies allowed the performance of thoracic spinal anesthesia for several procedures, without neurological sequelae studying 1,406 patients, at different puncture levels, with two puncture positions (lateral and sitting), and with two types of needles, pencil tip and cutting tip.…”

Section: Introductionmentioning

confidence: 99%

Segmental thoracic anesthesia for transabdominal colectomy with spontaneous ventilation through combined spinal-epidural block. Case report with video

Imbelloni, MD, PhD,

Fornasari, MD,

Sant’Anna, MD

et al. 2024

JACCOA

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Introduction: The combined spinal-epidural (CSE) technique offers advantages over the epidural or single injection spinal anesthesia alone. Assessing the distance between the dura mater and the spinal cord in the thoracic region with magnetic resonance imaging showed that there is a large space that allows the needle to enter without reaching the spinal cord. Segmental thoracic spinal anesthesia is being used in several types of surgery. Case report: A woman aged 73 years, 64 kg, 163 cm, physical status ASA II, type II diabetic, with systemic arterial hypertension, was scheduled for resection of a tumor in the right colon. The CSE was placed at the T9-T10 interspace and 10mg 0.5% hyperbaric bupivacaine was injected into the subarachnoid space. The epidural catheter (20G) was then inserted four centimeters. Sedation was obtained with 1mg of midazolam as needed (total 5mg). Two hours after 0.5% bupivacaine had to be administered in a bolus of 25 mg through the catheter. There was no necessity for the use of vasopressor drugs or atropine. Conclusion: This case has provided evidence that segmental spinal anesthesia can be an effective anesthetic technique for gastrointestinal surgery with spontaneous ventilation, and the infusion of 0.1% bupivacaine with an elastomeric pump provided 40 hours of analgesia.

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The anatomy of the thoracic spinal canal investigated with magnetic resonance imaging in children aged 0 to 13 years old

Cited by 4 publications

References 20 publications

Comparison of the Skin-to-Epidural Space Distance at the three Thoracic levels in Children using Magnetic Resonance Imaging for Epidural Anesthesia

Comparison of the Skin-to-Epidural Space Distance at the three Thoracic levels in Children using Magnetic Resonance Imaging for Epidural Anesthesia

Old anatomy and new anatomical concepts for single shot and continuous spinal anesthesia

Segmental thoracic anesthesia for transabdominal colectomy with spontaneous ventilation through combined spinal-epidural block. Case report with video

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