Mathematical Models for the Skin to Lumbosacral Epidural Distance in Dogs: A Cadaveric Computed-Tomography Study

Abstract

Simple SummaryEpidural anaesthesia is readily performed in the lumbosacral area in dogs that are undergoing surgery of the hindlimbs or the abdomen. Common techniques that are used to identify the epidural space rely on subtle changes in tactile and audible sensations which are challenging for less experienced clinicians. Research in humans suggest that mathematical equations that are derived from body surface parameters may improve the success of epidural space identification. In a previous study by this research group, we developed two mathematical equations from computed tomography (CT) measurements using dog surface parameters and a body condition score to predict the skin to lumbosacral epidural space. In this study, we aimed to validate the equations in dog cadavers against a gold standard technique (epidurography). For one equation, the use of the occipital-coccygeal length and body condition score resulted in a high degree of correlation and agreement with the skin to lumbosacral epidural space of the cadavers. Future studies will determine whether the knowledge of the skin to lumbosacral epidural space distance prior to needle placement improves the success of epidural space identification.This study aimed to validate previously published computed tomography (CT) derived mathematical equations with the true skin to lumbosacral epidural distance (SLED) in dog cadavers. Phase 1: The lumbar region of 11 dog cadavers were scanned in sternal recumbency to determine the effect of cranial, neutral, and caudal pelvic limb positioning on the CT derived lumbosacral epidural distance (CLED). Phase 2: The epidural space was determined using contrast epidurography, and the SLED was analysed against the mathematical equations using a body condition score (BCS) and either the cadaveric occipital-coccygeal length (OCL) (Equation (1): = 7.3 + 0.05*OCL + 16.45*BCS) or the ilium wing distance (IWD) (Equation (2): = 3.5 + 0.56*IWD + 16.6*BCS). There were no differences detected between the pelvic limb positions and the CLED. Both equations demonstrated strong correlations (Equation (1): r = 0.7196; Equation (2): r = 0.7590) with the SLED. The level of agreement was greater for Equation (1) than with Equation (2) (concordance coefficient 0.6061 and 0.3752, respectively). Equation (1) also demonstrated a closer fit to the concordance line compared with Equation (2) (bias correction factor 0.8422 and 0.4960, respectively). Further studies in live anaesthetised dogs will help to determine the usefulness of the pre-procedural knowledge when performing lumbosacral epidurals.