The Utility of Ultrasound Imaging in Predicting Ease of Performance of Spinal Anesthesia in an Orthopedic Patient Population

Abstract

Ultrasound can be useful in predicting the absence of technical difficulty in performing dural puncture and thus in selecting the optimal intervertebral level for spinal anesthesia.

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].…”

Facet joint degeneration adversely affects ultrasound imaging of the lumbar spine

“…Poor neuraxial ultrasound views in our study was strongly associated with facet joint degeneration. This might explain the high false negative rates of TM view [2]. This might also explain the fact that the PSO view did not have any correlation with facet degeneration.…”

“…Good visibility of ligamentum flavum-dura mater complex (Posterior Complex -PC) and posterior longitudinal ligament (Anterior Complex -AC) in neuraxial ultrasound is a predictor of successful neuraxial block [1]. Unfortunately, a high negative predictive value (approximately 30% [2]) limits its clinical value in patients deemed to be at risk of a technically difficult neuraxial block.…”

http://www.medultrason.ro/ultrasound-in-the-examination-of-the-gallbladder-a-holistic-approach-grey-scale-doppler-ceus-elastography-and-3d/

“…Pre-procedure scanning has also shown to have an 85% positive predictive value for successful dural puncture [29]. If one can see both AC and PC in TM view, it indicates that there is a clear path for the US beam to pass, and hence the likelihood of inserting a spinal or epidural needle into the intended space is higher.…”

“…Good visualisation of both AC and PC in transverse median view corresponds to successful administration of spinal anaesthetic in that level. However this has not been the case with PSO views [29]. Hence the inter-spinous space at which the best views of AC and PC is obtained in TM view should be selected.…”