PDF(Pubmed)
Abstract：
The use of ultrasound has been reported to be beneficial in challenging neuraxial procedures. The angled probe is responsible for the main limitations of previous ultrasound-assisted techniques. We developed a novel technique for challenging lumbar puncture, aiming to locate the needle entry point which allowed for a horizontal and perpendicular needle trajectory and thereby addressed the drawbacks of earlier ultrasound-assisted techniques.
Patient 1 was an adult patient with severe scoliosis who underwent a series of intrathecal injections of nusinersen. The preprocedural ultrasound scan revealed a cephalad probe\'s angulation (relative to the edge of the bed) in the paramedian sagittal oblique view, and then the probe was rotated 90° into a transverse plane and we noted that a rocking maneuver was required to obtain normalized views. Then the shoulders were moved forward to eliminate the need for cephalad angulation of the probe. The degree of rocking was translated to a lateral offset from the midline of the spine through an imaginary lumbar puncture\'s triangle model, and a needle entry point was marked. The spinal needle was advanced through this marking-point without craniocaudal and lateromedial angulation, and first-pass success was achieved in all eight lumbar punctures. Patient 2 was an elderly patient with ankylosing spondylitis who underwent spinal anesthesia for transurethral resection of the prostate. The patient was positioned anteriorly obliquely to create a vertebral rotation that eliminated medial angulation in the paramedian approach. The procedure succeeded on the first pass.
This ultrasound-assisted paramedian approach with a horizontal and perpendicular needle trajectory may be a promising technique that can help circumvent challenging anatomy. Larger case series and prospective studies are warranted to define its superiority to alternative approaches of lumbar puncture for patients with difficulties.
Patient 1 was an adult patient with severe scoliosis who underwent a series of intrathecal injections of nusinersen. The preprocedural ultrasound scan revealed a cephalad probe\'s angulation (relative to the edge of the bed) in the paramedian sagittal oblique view, and then the probe was rotated 90° into a transverse plane and we noted that a rocking maneuver was required to obtain normalized views. Then the shoulders were moved forward to eliminate the need for cephalad angulation of the probe. The degree of rocking was translated to a lateral offset from the midline of the spine through an imaginary lumbar puncture\'s triangle model, and a needle entry point was marked. The spinal needle was advanced through this marking-point without craniocaudal and lateromedial angulation, and first-pass success was achieved in all eight lumbar punctures. Patient 2 was an elderly patient with ankylosing spondylitis who underwent spinal anesthesia for transurethral resection of the prostate. The patient was positioned anteriorly obliquely to create a vertebral rotation that eliminated medial angulation in the paramedian approach. The procedure succeeded on the first pass.
This ultrasound-assisted paramedian approach with a horizontal and perpendicular needle trajectory may be a promising technique that can help circumvent challenging anatomy. Larger case series and prospective studies are warranted to define its superiority to alternative approaches of lumbar puncture for patients with difficulties.
摘要：
背景：据报道，超声的使用在具有挑战性的神经轴手术中是有益的。成角度的探头是造成先前超声辅助技术的主要限制的原因。我们开发了一种挑战腰椎穿刺的新技术，旨在定位允许水平和垂直针轨迹的针进入点，从而解决了早期超声辅助技术的缺点。
方法：患者1是一名患有严重脊柱侧凸的成年患者，接受了一系列鞘内注射nusinersen。术前超声扫描显示，在旁正中矢状斜视图中，头部探头的角度（相对于床的边缘），然后将探头旋转90°进入横向平面，我们注意到需要进行摇摆操作才能获得归一化视图。然后将肩部向前移动以消除对探头的头部成角度的需要。通过一个假想的腰椎穿刺三角形模型，摇摆程度被转化为从脊柱中线的横向偏移，并标记了一个针入口点。脊柱穿刺针穿过这个标记点，没有头尾和外侧内侧角度，在所有八次腰椎穿刺中都取得了首过成功。患者2是患有强直性脊柱炎的老年患者,其接受经尿道前列腺电切术的脊髓麻醉。将患者向前倾斜放置，以产生椎骨旋转，从而消除了旁正中入路中的内侧角度。该过程在第一遍成功。
结论：这种具有水平和垂直针轨迹的超声辅助旁正中入路可能是一种有前途的技术，可以帮助规避具有挑战性的解剖结构。有必要进行更大的病例系列和前瞻性研究，以确定其对困难患者的腰椎穿刺替代方法的优越性。
方法：患者1是一名患有严重脊柱侧凸的成年患者，接受了一系列鞘内注射nusinersen。术前超声扫描显示，在旁正中矢状斜视图中，头部探头的角度（相对于床的边缘），然后将探头旋转90°进入横向平面，我们注意到需要进行摇摆操作才能获得归一化视图。然后将肩部向前移动以消除对探头的头部成角度的需要。通过一个假想的腰椎穿刺三角形模型，摇摆程度被转化为从脊柱中线的横向偏移，并标记了一个针入口点。脊柱穿刺针穿过这个标记点，没有头尾和外侧内侧角度，在所有八次腰椎穿刺中都取得了首过成功。患者2是患有强直性脊柱炎的老年患者,其接受经尿道前列腺电切术的脊髓麻醉。将患者向前倾斜放置，以产生椎骨旋转，从而消除了旁正中入路中的内侧角度。该过程在第一遍成功。
结论：这种具有水平和垂直针轨迹的超声辅助旁正中入路可能是一种有前途的技术，可以帮助规避具有挑战性的解剖结构。有必要进行更大的病例系列和前瞻性研究，以确定其对困难患者的腰椎穿刺替代方法的优越性。
