PDF(Pubmed)
Abstract：
BACKGROUND: Lumbar puncture is challenging for patients with scoliosis. Previous ultrasound-assisted techniques for lumbar puncture used the angle of the probe as the needle trajectory; however, reproducing the angle is difficult and increases the number of needle manipulations. In response, we developed a technique that eliminated both the craniocaudal and lateromedial angulation of the needle trajectory to overall improve this technique. We assessed the feasibility and safety of this method in patients with scoliosis and identify factors related to difficult lumbar puncture.
METHODS: Patients with spinal muscular atrophy and scoliosis who were referred to the anesthesia department for intrathecal nusinersen administrations were included. With a novel approach that utilized patient position and geometry, lumbar puncture was performed under ultrasound guidance. Success rates, performance times and adverse events were recorded. Clinical-demographic and spinal radiographic data pertaining to difficult procedures were analyzed.
RESULTS: Success was achieved in all 260 (100%) lumbar punctures for 44 patients, with first pass and first attempt success rates of 70% (183/260) and 87% (226/260), respectively. Adverse events were infrequent and benign. Higher BMI, greater skin dural sac depth and smaller interlaminar size might be associated with greater difficulty in lumbar puncture.
CONCLUSIONS: The novel ultrasound-assisted horizontal and perpendicular interlaminar needle trajectory approach is an effective and safe method for lumbar puncture in patients with spinal deformities. This method can be reliably performed at the bedside and avoids other more typical and complex imaging such as computed tomography guided procedure.
METHODS: Patients with spinal muscular atrophy and scoliosis who were referred to the anesthesia department for intrathecal nusinersen administrations were included. With a novel approach that utilized patient position and geometry, lumbar puncture was performed under ultrasound guidance. Success rates, performance times and adverse events were recorded. Clinical-demographic and spinal radiographic data pertaining to difficult procedures were analyzed.
RESULTS: Success was achieved in all 260 (100%) lumbar punctures for 44 patients, with first pass and first attempt success rates of 70% (183/260) and 87% (226/260), respectively. Adverse events were infrequent and benign. Higher BMI, greater skin dural sac depth and smaller interlaminar size might be associated with greater difficulty in lumbar puncture.
CONCLUSIONS: The novel ultrasound-assisted horizontal and perpendicular interlaminar needle trajectory approach is an effective and safe method for lumbar puncture in patients with spinal deformities. This method can be reliably performed at the bedside and avoids other more typical and complex imaging such as computed tomography guided procedure.
摘要：
背景：腰椎穿刺对脊柱侧凸患者具有挑战性。以前的超声辅助腰椎穿刺技术使用探头的角度作为针的轨迹；然而，复制角度是困难的，并且增加了针操作的数量。作为回应,我们开发了一种技术，该技术消除了针头轨迹的头尾和内侧角度，以整体改进该技术。我们评估了这种方法在脊柱侧凸患者中的可行性和安全性，并确定了与腰椎穿刺困难相关的因素。
方法：纳入了脊髓性肌萎缩和脊柱侧凸患者，这些患者被转诊到麻醉部门进行鞘内注射。通过一种利用患者位置和几何形状的新颖方法，腰椎穿刺在超声引导下进行.成功率,记录性能时间和不良事件.分析了与困难程序有关的临床人口统计学和脊柱影像学数据。
结果：44例患者的260例（100%）腰椎穿刺均成功，首次通过和首次尝试成功率为70％（183/260）和87％（226/260），分别。不良事件罕见且良性。BMI较高,较大的皮肤硬膜囊深度和较小的层间尺寸可能与腰椎穿刺难度较大有关。
结论：新型超声辅助水平和垂直椎板间针轨迹入路是脊柱畸形患者腰椎穿刺安全有效的方法。该方法可以在床边可靠地执行,并且避免其他更典型和复杂的成像,诸如计算机断层摄影引导程序。
方法：纳入了脊髓性肌萎缩和脊柱侧凸患者，这些患者被转诊到麻醉部门进行鞘内注射。通过一种利用患者位置和几何形状的新颖方法，腰椎穿刺在超声引导下进行.成功率,记录性能时间和不良事件.分析了与困难程序有关的临床人口统计学和脊柱影像学数据。
结果：44例患者的260例（100%）腰椎穿刺均成功，首次通过和首次尝试成功率为70％（183/260）和87％（226/260），分别。不良事件罕见且良性。BMI较高,较大的皮肤硬膜囊深度和较小的层间尺寸可能与腰椎穿刺难度较大有关。
结论：新型超声辅助水平和垂直椎板间针轨迹入路是脊柱畸形患者腰椎穿刺安全有效的方法。该方法可以在床边可靠地执行,并且避免其他更典型和复杂的成像,诸如计算机断层摄影引导程序。
