title: The use of ultrasound to facilitate spinal anesthesia in a patient with previous lumbar laminectomy and fusion: a case report.
abstract: We describe a case of ultrasound (US)-facilitated spinal anesthesia in a patient with a prior lumbar laminectomy and spinal fusion who presented for total knee arthroplasty. Traditional, landmark-guided spinal anesthesia had previously failed. Although pre-procedural US identified a soft-tissue window at L3/4, a 25G pencilpoint needle encountered resistance. Reassured from US imaging that this was not bone, we used a 22G cutting tip needle successfully. We believe spinal anesthesia would not have been possible in this patient without US, adding to the evidence that US-facilitated neuraxial anesthesia is useful, particularly in technically difficult, if not 'impossible,' cases.
authors.affiliation: Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, Ontario, Canada.
authors.forename: Ki Jinn
authors.initials: KJ
authors.lastname: Chin
authors.forename: Alan J R
authors.initials: AJ
authors.lastname: Macfarlane
authors.forename: Vincent
authors.initials: V
authors.lastname: Chan
authors.forename: Richard
authors.initials: R
authors.lastname: Brull
mesh_terms: D000775:Anesthesia, Spinal / Q000379:methods*; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D006801:Humans; D007796:Laminectomy; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery*; D015203:Reproducibility of Results; D013123:Spinal Fusion; D013346:Subarachnoid Space / Q000000981:diagnostic imaging*; D014463:Ultrasonography