<br />
Ultrasound<br />
Ultrasonography of the adult lumbar<br />
spine for central neuraxial blockade<br />
Philips tutorial<br />
Ki Jinn Chin, MD, FRCPC<br />
Assistant Professor, Department of Anesthesia, Toronto Western Hospital<br />
University of Toronto, Toronto, Ontario, Canada<br />
Vincent Chan, MD, FRCPC<br />
Professor, Department of Anesthesia, Toronto Western Hospital<br />
University of Toronto, Toronto, Ontario, Canada<br />
Contents<br />
Ultrasonography of the adult lumbar spine<br />
for central neuraxial blockade<br />
1 Introduction 3<br />
2 Gross anatomy 4<br />
3 Sonographic technique<br />
and sonoanatomy 9<br />
4 Clinical pearls and tips 30<br />
5 Indications for use 36<br />
6 Conclusion 39<br />
7 References <a title="Adult lumbar spine for central neuraxial blockade Tutorial_ page 1" href="http://viewer.zmags.com/publication/70ed5a23?page=1"> Ultrasound Ultrasonography of the adult lumbar s</a>
<a title="Adult lumbar spine for central neuraxial blockade Tutorial_ page 2" href="http://viewer.zmags.com/publication/70ed5a23?page=2"> Contents Ultrasonography of the adult lumbar s</a>
<a title="Adult lumbar spine for central neuraxial blockade Tutorial_ page 3" href="http://viewer.zmags.com/publication/70ed5a23?page=3"> 1 Introduction The application of ultra</a>
<a title="Adult lumbar spine for central neuraxial blockade Tutorial_ page 4" href="http://viewer.zmags.com/publication/70ed5a23?page=4"> 2 Gross anatomy General anatomy of the spine</a>
<a title="Adult lumbar spine for central neuraxial blockade Tutorial_ page 5" href="http://viewer.zmags.com/publication/70ed5a23?page=5"> [Figure 1] Three-quarter oblique view (A) and pos</a>
<a title="Adult lumbar spine for central neuraxial blockade Tutorial_ page 6" href="http://viewer.zmags.com/publication/70ed5a23?page=6"> Within the vertebral canal lie the thecal sac (fo</a>
<a title="Adult lumbar spine for central neuraxial blockade Tutorial_ page 7" href="http://viewer.zmags.com/publication/70ed5a23?page=7"> These spaces are further enlarged by forward flex</a>
<a title="Adult lumbar spine for central neuraxial blockade Tutorial_ page 8" href="http://viewer.zmags.com/publication/70ed5a23?page=8"> Supraspinous ligament Interspinous ligament Lig</a>
<a title="Adult lumbar spine for central neuraxial blockade Tutorial_ page 9" href="http://viewer.zmags.com/publication/70ed5a23?page=9"> 3 Sonographic technique and sonoanatomy </a>
<a title="Adult lumbar spine for central neuraxial blockade Tutorial_ page 10" href="http://viewer.zmags.com/publication/70ed5a23?page=10"> Transverse plane Coronal plane </a>
<a title="Adult lumbar spine for central neuraxial blockade Tutorial_ page 11" href="http://viewer.zmags.com/publication/70ed5a23?page=11"> Ultrasonographic views of the spine Pattern recog</a>
<a title="Adult lumbar spine for central neuraxial blockade Tutorial_ page 12" href="http://viewer.zmags.com/publication/70ed5a23?page=12"> There are five basic ultrasonographic views 1. P</a>
<a title="Adult lumbar spine for central neuraxial blockade Tutorial_ page 13" href="http://viewer.zmags.com/publication/70ed5a23?page=13"> [Figure 4] Paramedian sagittal transverse process</a>
<a title="Adult lumbar spine for central neuraxial blockade Tutorial_ page 14" href="http://viewer.zmags.com/publication/70ed5a23?page=14"> 2. Paramedian sagittal (PS) articular process vie</a>
<a title="Adult lumbar spine for central neuraxial blockade Tutorial_ page 15" href="http://viewer.zmags.com/publication/70ed5a23?page=15"> [Figure 5] Paramedian sagittal articular process </a>
<a title="Adult lumbar spine for central neuraxial blockade Tutorial_ page 16" href="http://viewer.zmags.com/publication/70ed5a23?page=16"> 3. Paramedian sagittal (PS) oblique view Onc</a>
<a title="Adult lumbar spine for central neuraxial blockade Tutorial_ page 17" href="http://viewer.zmags.com/publication/70ed5a23?page=17"> [Figure 6] Paramedian sagittal oblique view of th</a>
<a title="Adult lumbar spine for central neuraxial blockade Tutorial_ page 18" href="http://viewer.zmags.com/publication/70ed5a23?page=18"> Small sliding and tilting movements of the transd</a>
<a title="Adult lumbar spine for central neuraxial blockade Tutorial_ page 19" href="http://viewer.zmags.com/publication/70ed5a23?page=19"> [ Video 1 ] Video </a>
<a title="Adult lumbar spine for central neuraxial blockade Tutorial_ page 20" href="http://viewer.zmags.com/publication/70ed5a23?page=20"> Accurate identification of intervertebral spaces </a>
<a title="Adult lumbar spine for central neuraxial blockade Tutorial_ page 21" href="http://viewer.zmags.com/publication/70ed5a23?page=21"> [Figure 7] Paramedian sagittal oblique view of th</a>
<a title="Adult lumbar spine for central neuraxial blockade Tutorial_ page 22" href="http://viewer.zmags.com/publication/70ed5a23?page=22"> [Figure 8] Surface marking to guide needle insert</a>
<a title="Adult lumbar spine for central neuraxial blockade Tutorial_ page 23" href="http://viewer.zmags.com/publication/70ed5a23?page=23"> [ Video 2 ] Video demo</a>
<a title="Adult lumbar spine for central neuraxial blockade Tutorial_ page 24" href="http://viewer.zmags.com/publication/70ed5a23?page=24"> 4. Transverse spinous process view Having c</a>
<a title="Adult lumbar spine for central neuraxial blockade Tutorial_ page 25" href="http://viewer.zmags.com/publication/70ed5a23?page=25"> [Figure 9] Transverse spinous process view of the</a>
<a title="Adult lumbar spine for central neuraxial blockade Tutorial_ page 26" href="http://viewer.zmags.com/publication/70ed5a23?page=26"> 5. Transverse interlaminar view Sliding the</a>
<a title="Adult lumbar spine for central neuraxial blockade Tutorial_ page 27" href="http://viewer.zmags.com/publication/70ed5a23?page=27"> [Figure 10] Transverse interlaminar view of the l</a>
<a title="Adult lumbar spine for central neuraxial blockade Tutorial_ page 28" href="http://viewer.zmags.com/publication/70ed5a23?page=28"> [ Video 3] Video d</a>
<a title="Adult lumbar spine for central neuraxial blockade Tutorial_ page 29" href="http://viewer.zmags.com/publication/70ed5a23?page=29"> Unlike the PS oblique view, the ligamentum flavum</a>
<a title="Adult lumbar spine for central neuraxial blockade Tutorial_ page 30" href="http://viewer.zmags.com/publication/70ed5a23?page=30"> 4 Clinical pearls Accuracy of skin marking I</a>
<a title="Adult lumbar spine for central neuraxial blockade Tutorial_ page 31" href="http://viewer.zmags.com/publication/70ed5a23?page=31"> The obese patient In obese patients, structures a</a>
<a title="Adult lumbar spine for central neuraxial blockade Tutorial_ page 32" href="http://viewer.zmags.com/publication/70ed5a23?page=32"> The elderly patient The problem in elderly patien</a>
<a title="Adult lumbar spine for central neuraxial blockade Tutorial_ page 33" href="http://viewer.zmags.com/publication/70ed5a23?page=33"> [ Video 4 ] Video </a>
<a title="Adult lumbar spine for central neuraxial blockade Tutorial_ page 34" href="http://viewer.zmags.com/publication/70ed5a23?page=34"> [ Video 5 ] Video </a>
<a title="Adult lumbar spine for central neuraxial blockade Tutorial_ page 35" href="http://viewer.zmags.com/publication/70ed5a23?page=35"> 5 Indications for use There are three main a</a>
<a title="Adult lumbar spine for central neuraxial blockade Tutorial_ page 36" href="http://viewer.zmags.com/publication/70ed5a23?page=36"> There is also some evidence that ultrasound-guida</a>
<a title="Adult lumbar spine for central neuraxial blockade Tutorial_ page 37" href="http://viewer.zmags.com/publication/70ed5a23?page=37"> 3. Identification of intervertebral level In</a>
<a title="Adult lumbar spine for central neuraxial blockade Tutorial_ page 38" href="http://viewer.zmags.com/publication/70ed5a23?page=38"> Errors are more likely in the early stages of lea</a>
<a title="Adult lumbar spine for central neuraxial blockade Tutorial_ page 39" href="http://viewer.zmags.com/publication/70ed5a23?page=39"> 6 Conclusion Ultrasound-guided neuraxial blo</a>
<a title="Adult lumbar spine for central neuraxial blockade Tutorial_ page 40" href="http://viewer.zmags.com/publication/70ed5a23?page=40"> 7 References 1. de Filho GR, Gomes HP,</a>
<a title="Adult lumbar spine for central neuraxial blockade Tutorial_ page 41" href="http://viewer.zmags.com/publication/70ed5a23?page=41"> 20. Yamauchi M, Honma E, Mimura M, Yamamoto H, Ta</a>
<a title="Adult lumbar spine for central neuraxial blockade Tutorial_ page 42" href="http://viewer.zmags.com/publication/70ed5a23?page=42"> 36. Chin KJ, Perlas A, Singh M, Arzola C, Prasad</a>
<a title="Adult lumbar spine for central neuraxial blockade Tutorial_ page 43" href="http://viewer.zmags.com/publication/70ed5a23?page=43"> 54. Karmakar MK. Ultrasound for central neuraxia</a>
<a title="Adult lumbar spine for central neuraxial blockade Tutorial_ page 44" href="http://viewer.zmags.com/publication/70ed5a23?page=44"> Additional resources For additional resources</a>
<a title="Adult lumbar spine for central neuraxial blockade Tutorial_ page 45" href="http://viewer.zmags.com/publication/70ed5a23?page=45"> This paper reflects the opinion of the author, no</a>