Palpation Of Spinous Processes Research Articles

The influence of body painting on L4 spinous process palpation accuracy in novice palpators

ABSTRACT Objectives Current literature remains inconclusive regarding the best methodology to accurately palpate lumbar spinous processes (SP). Body painting (BP) uses markers to draw anatomical structures on the skin’s surface. While BP can be a useful tool for engaging learners, it is unknown whether it improves palpation accuracy. The purpose of this study was to investigate whether the addition of body painting to palpation education improves lumbar spinous process palpation accuracy in first-year Doctor of Physical Therapy (DPT) students. Methods Thirty-eight DPT students were randomized into a traditional palpation group and a body painting (BP) group. Each group received identical instruction on palpating the lumbar spine, with the BP group additionally drawing lumbar SPs on their laboratory partner with a marker. Students were then assessed on their ability to accurately palpate the L4 SP on randomly assigned subjects. Two Certified Registered Nurse Anesthetists (CRNAs) used ultrasound imaging to confirm the location of each student’s palpation. Palpation time was also recorded. The BP group also completed a survey on the learning experience. Results Forty-five percent of students were able to accurately palpate the L4 SP. There was no significant difference (p = 0.78) in palpation accuracy between the traditional and BP group, although students in the BP group were randomly assigned subjects with a significantly (p = 0.005) higher BMI. Ninety-five percent of students were able to palpate within one spinal level of the L4 SP. Students in the BP group reported that the BP activity facilitated learning and active participation. There was no significant difference in palpation time (p = 0.98) between groups. There was a fair correlation (r=-0.41) between palpation accuracy and subject BMI. Discussion/Conclusion While body painting was an enjoyable activity to incorporate into palpation laboratory, it is unclear whether it enhanced lumbar SP palpation accuracy in first-year DPT students.

Pendant Positioning Vs Traditional Sitting for Successful Spinal Punctures in Elderly

Background- The ability of the pendant position in increasing the intervertebral spaces translating in an increase in the 1st attempt spinal puncture success rate has been reported in pregnant females undergoing cesarean section. However, the same has not been done for the elderly patients in which age-related degenerative anatomical changes, decreased lordosis, disseminated sclerosis, and extensive osteophytosis is known to reduce the intervertebral space. Materials and Methods- A prospective randomized controlled study was conducted in patients aged 60-80 years undergoing urological surgeries after approvalfrom the Institutional Ethics Committee and written informed consent from the patients. Primary aim was to compare the number of bone contacts during administration of subarachnoid block with the patient in either pendant (Group A) or traditional (Group B) position. Secondary aims were to compare the proportion of successful spinal needle placements, ease of palpation of spinous processes, patient’s comfort, number of spaces used, time to perform spinal puncture, time to reach grade III (as per modified bromage score) motor blockade, time to reach T10 sensory level and rate of complications in both the groups. Results- Demographic data was comparable and there was no statistical difference in number of bone contacts, ease of administration, success of spinal needle placements, performance times of subarachnoid block and duration of spinal anaesthesia in both the groups. Complication rates were comparable. Conclusion- Pendant positioning does not confer any advantage over the traditional sitting position in success rates and performance characteristics of subarachnoid block in elderly (60-80 years) patients scheduled for urological surgeries. Keywords: Pendant position, Spinal-bone contact, Spinal Needle Puncture, Lumbar puncture, Spinal anesthesia, Aged

A Prospective Observational Study to Determine the Predictors of Increased Number of Attempts at Labour Epidural Placement.

ObjectiveMultiple attempts at labour epidural placement result in patient discomfort and high incidence of complications. Identifying the factors that lead to more than one attempt would help anaesthesiologists prepare in advance such as getting expert help and additional equipment, patient counselling or planning alternative management.MethodsThis prospective observational study was conducted on 500 patients from July 2017 to June 2018 after obtaining approval from the institutional Ethics Review Committee. The study patients consisted of full-term parturient women who were admitted in the labour room suite of Aga Khan Hospital requesting for labour epidural and consented to participate in the study. A predesigned form was used to collect the following data: number of attempts at epidural insertion and factors such as patients’ demographics, cervical dilatation, anatomical grading of spine according to visibility and palpation of spinous process and vertebral interspace, experience level of the anaesthesiologist, patient satisfaction and pain score during labour.ResultsThe average age of the patients was 28.11±4.02 years. The total number of epidural attempts varied between one and four; the median number of attempts was 1 [IQR=1–2]. Anatomical grade of the spine was the only factor that was significantly associated with more than one attempt at epidural insertion (p=0.0005). Patient satisfaction was negatively associated with the number of attempts (p=0.04), but mean pain difference at different time points during the course of labour was not statistically significant between patients with one attempt and those with more than one attempt.ConclusionDetermining the anatomical grade of the spine is the most reliable method for predicting a technically difficult neuraxial block that requires more than one attempt at epidural insertion.

Morphological parameters of fourth lumbar spinous process palpation: a three-dimensional reconstruction of computed tomography

BackgroundThe localization of lumbar fourth spinous process (L4-SP) is an important anatomical landmark, and identifying its accurate position is essential for the diagnosis and treatment of waist diseases.MethodsFive hundred participants were scanned with positive and lateral computed tomography (CT), which aimed to clarify anatomic characteristics of L4-SP. Anatomical parameters of the surface localization of L4-SP were measured and recorded through a three-dimensional (3D) reconstruction.ResultsFive hundred participants were classified into three types according to the position of BC with the iliac spine. There are just 266 that the line between the highest point of the iliac spine on both sides located on L4-SP (type I, 53.20%), 16 above L4-SP (type II, 3.20%), and 218 below L4-SP (type III, 43.60%). BC in type I (15.92 ± 1.30 mm) is longer than type III (15.56 ± 1.32 mm). While the angle combined with AB and BC is different in the three groups, the angle in type I (173.00 ± 4.83°) is larger than that in type II (164.69 ± 5.50°) and type III (159.45 ± 8.39°). Other measurements were not found any significant differences between above.ConclusionThe traditional palpation for L4-SP is not absolutely exact. The accuracy rate is only 53.20%, and the errors may cause serious consequences.

FEATURES OF SURGICAL TACTICS FOR PATIENTS WITH COXO-VERTEBRAL SYNDROME

Purpose of the study – to design the algorithm of selection for rational surgical tactics for treatment of patients with coxo-vertebral syndrome.Material and methods. 175 patients with coxo-vertebral syndrome were included into the study who underwent total hip replacement in the period from 2009 till 2016. The authors analyzed outcomes of treatment of 134 patients at midterm follow up of 9 months (range from 8 to 10 months) after the surgery. Mean age of patients was 54,4±12,7 y.o. Patients were subdivided into a test group (94 patients) and control group (81 patients). Standard THR approaches were used in the control group by restoring anatomical center of rotation and lower leg length. The suggested algorithm of the optimal procedure selection was applied in the test group. Clinical and functional data was evaluated by Harris Hip Score and Oswestry score. Radiographic evaluation was performed based on x-rays of vertebral-pelvic complex in standing position, by functional x-rays, CT and MRI. Evaluation of differences significance between the groups was performed by MannWhitney U-test and McNemar test.Results. Application of proposed surgical approaches allowed to increase the number of patients with good clinical and functional outcomes (test group – 82,4%, control group – 26,7%) and achieve better function of hip joint and patients’ life quality in short-term postoperative period. Excellent outcomes by Harris hip score were observed in 53,2% of patients, in control group – in 9,7%. Share of the patients complaining of lumber pain, limping and need for a walking stick after THR in the test group was less than in control group. Share of patients demonstrating pain at palpation of spinous processes, with positive test of elevated extended leg and radicular syndrome was also significantly less in test group as compared to control group.Conclusion. Practical application of proposed algorithm for selection of a rational tactics of surgical treatment for patients with combined degenerative and distrophic pathology of the hip joint and spine allows in short-term after THR to statistically significantly improve treatment outcomes in comparison with patients that underwent conventional preoperative planning and THR.

Identification of the Correct Cervical Level by Palpation of Spinous Processes

Identification of the Correct Cervical Level by Palpation of Spinous Processes

Complex Pathogenetic Therapyof Neurovascular Syndromes Resulted from Degenerative-Dystrophic Changes in the Lumbosacral Spine

Objective. To estimate the efficacy of reflex action in complex pathogenetic therapy of neurovascular syndrome resulted from degenerative-dystrophic changes in the spine. Material and Methods. Overall 97 patients with nerve root syndromes associated with intervertebral disc hernia were followed up. All patients, after general clinical examination, were divided in two groups depending on treatment particularities. Control group patients underwent drug therapy, and in study group patients drug therapy was accompanied with acupuncture, myostimulation, and therapeutic massage. Pain syndrome and neurologic functions were evaluated at 1, 5, 10 and 15 day of treatment. Results. After 10 days of treatment clinical improvement expressed in pain relief was observed in 96.4 % of study group patients and in 87.6 % of control group ones. Palpation of spinous processes and paravertebral muscles showed relaxation and pain relief in 100.0 % of cases in both groups at 5 day of treatment. Stretch symptom regressed in all patients of both groups by 15 day. Above well marked relief in pain intensity a pronounced regression of neurological symptoms was observed in patients of the study group. Conclusion. Complex treatment including drug-free therapy provides relief in pain intensity, and accounts for better restoration of peripheral blood circulation for shorter treatment duration.

Identification of the Correct Cervical Level by Palpation of Spinous Processes

The ability to identify the correct vertebral level through examination is an important skill for clinicians who are performing nerve blocks without fluoroscopy. The conventional palpation method, which identifies the most prominent cervical spinous process as the seventh cervical (C7) spinous process is unreliable in many cases. We compared the accuracy of 2 different palpation methods used for identifying C7. Ninety-six patients scheduled for cervical spine procedures under fluoroscopy guidance were randomized into either the control group or the flexion-extension group. The control group was examined with the conventional method, and the flexion-extension group was examined through assisted flexion and extension of the patient's cervical spine and identifying the lowest freely moving spinous process as C6 and the following stationary cervical spinous process as C7. A single anesthesiologist attempted to identify the C7 spinous process by using either the conventional method or the flexion-extension method and marked the presumed C7 spinous process with a radiopaque indicator. The actual vertebral level was then confirmed by fluoroscopy. The accuracy of the 2 different palpation techniques was compared, and the influence of patients' age, gender, and body mass index (BMI) was also examined. The C7 spinous process was correctly identified in 77.1% of patients in the flexion-extension group, compared with 37.5% in the control group (P<0.001). The C6 spinous process was identified as the most prominent cervical spinous process instead of C7 in 47.9% of patients in the control group, showing that errors are more common in the cephalad direction with the conventional method. The accuracy of the flexion-extension method was significantly higher than the conventional method regardless of the patient's age, gender, and BMI. Particularly, this difference in accuracy was seen not only in patients with a BMI <25 kg/m(2), but also in those with a BMI ≥25 kg/m(2) (BMI <25 kg/m(2), P=0.006 vs BMI ≥25 kg/m(2), P=0.008). The flexion-extension method is more accurate than the conventional method when identifying cervical vertebral level.

Spinous process palpation using the scapular tip as a landmark vs a radiographic criterion standard

Objective This study aimed at determining the standing spinal landmark that corresponds to the inferior tip of the scapula and determining the accuracy of experienced palpators in locating a spinous process (SP) 3 levels above and below a given SP. Methods The study participants were 34 asymptomatic or minimally symptomatic chiropractic students. An experienced palpator located the inferior scapular tip on each and then positioned a 2-mm lead marker about 5 cm lateral to the nearest SP. Two more markers were placed at levels intended to be 3 levels above and below the first marker placed. The locations of the scapular tip and the spinal targets were determined by comparison with a radiological criterion standard. Results The standing inferior scapular tip corresponded to the T8 SP on average (SD = 0.9). Having placed the first lead marker, examiners on average overshot the upper marker by 0.26 (SD = 0.51) vertebral levels and undershot the lower marker by 0.21 (SD = 0.48) vertebral levels. The modes for the placement of the 3 markers were at T5, T8, and T11. Conclusion Approximately 68% of patients would be palpated to have their inferior scapular tips at T7, T8, or T9. An experienced palpator can quite accurately locate vertebral levels 3 above or below a given landmark. Chiropractors and other health professionals using the typical rule of thumb linking the inferior scapular tip to the standing T7 SP have likely been applying clinical interventions at spinal locations different from those intended.

Lumbar Isthmic Spondylolisthesis Detection with Palpation: Interrater Reliability and Concurrent Criterion-Related Validity

Lumbar spinous process palpation to detect spondylolisthesis is a technique frequently used by clinicians and taught in professional education courses, but it has not been shown to be reliable or valid. The purpose of this study was to assess the diagnostic utility of lumbar spinous palpation as a means of detecting isthmic spondylolisthesis in patients with low back pain. Interrater reliability was assessed by pair-wise comparison of the findings of three therapists palpating the spinous processes on 30 subjects with low back pain. Validity was evaluated by comparing the findings of one therapist to a reference standard of plain film radiographs in 44 patients. The pair-wise kappa values were poor to fair at 0.179, 0.394, and 0.314. Validity testing revealed a sensitivity of 60% (95% CI, 14.7-94.7) and a specificity of 87.2% (95% CI, 72.6-95.7%). The positive likelihood ratio was 4.68 (95% confidence interval (CI): 1.57-13.88) and the negative likelihood ratio was 0.458 (95% CI, 0.155-1.35). Both likelihood ratios produced only a small change in pre- to post-test probabilities. Based on our results, static spinous process palpation by itself is not a definitive method for the detection of spondylolisthesis. However, the study data do not preclude the possible future use of palpation along with other, yet to be identified, validated predictive variables for isthmic spondylolisthesis.

On the Accuracy of Cervicothoracic Vertebral Level Determination by Palpation of Spinous Processes

On the Accuracy of Cervicothoracic Vertebral Level Determination by Palpation of Spinous Processes