Abstract
BackgroundSpondylolisthesis is a common degenerative spinal deformity. At the level of spondylolisthesis, the anatomy of the interlaminar space may differ from normal spine, in which case optimal angle of the needle insertion for spinal anesthesia may change. This study compared the optimal angle of needle insertion during spinal anesthesia in patients with and without lumbar spondylolisthesis using ultrasound.MethodsWe recruited 40 patients, 20 with and 20 without lumbar spondylolisthesis (group S and N, respectively). Ultrasonography was performed in the transverse midline and parasagittal oblique views at the spondylolisthesis level and the adjacent upper level. We measured the probe application angle with the longest interlaminar height of the ligamentum flavum-dura mater complex (LFD), depth from the skin to the LFD, depth from the skin to the anterior complex, and intrathecal space width. A positive angle represented a cephalad angulation.ResultsThe optimal needle insertion angle in the transverse midline view at the spondylolisthesis level was (-) 2.7 ± 3.4° in group S and 0.8 ± 2.5° in group N (P< 0.001). In the parasagittal oblique view, it was (-) 2.7 ± 4.5° in group S and 1.0 ± 3.2° in group N (P = 0.004). There were no between-group differences in the angles at the upper level, with all cephalad angles in both views. Other ultrasound image data were comparable between groups.ConclusionIn patients with spondylolisthesis, caudad angulation of the spinal needle can aid successful spinal puncture at spondylolisthesis level, both in the midline and paramedian approaches.Trial registrationwww.ClinicalTrials.gov (NCT04426916); registered 11 June 2020.
Highlights
Spondylolisthesis is a common degenerative spinal deformity
Considering the angles of the spinous process and interlaminar space during lumbar flexion, it is recommended that the spinal needle should be inserted at a slight cephalad angle for successful spinal puncture [5]
The anatomy of the interlaminar space through which the needle passes during spinal anesthesia can be altered due to the angles formed by the two vertebral bodies and spinous processes
Summary
At the level of spondylolisthesis, the anatomy of the interlaminar space may differ from normal spine, in which case optimal angle of the needle insertion for spinal anesthesia may change. This study compared the optimal angle of needle insertion during spinal anesthesia in patients with and without lumbar spondylolisthesis using ultrasound. Spinal anesthesia has been traditionally performed based on surface anatomical landmarks. With the widespread use of ultrasonography during spinal anesthesia, an approach based on individual anatomical characteristics has emerged [1, 2]. The anatomy of the interlaminar space through which the needle passes during spinal anesthesia can be altered due to the angles formed by the two vertebral bodies and spinous processes. The optimal angle of needle trajectory in these patients may be different from that in the general population [7, 8]
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