title: An ultrasound-assisted approach facilitates spinal anesthesia for total joint arthroplasty.
abstract: OBJECTIVE
  Spinal anesthesia can be challenging in patients undergoing total joint arthroplasty because of poorly palpable surface landmarks and age-related changes in the lumbar spine. We hypothesized that pre-procedural ultrasound imaging would be effective in identifying the lumbar intervertebral spaces and would provide an accurate measure of the depth to the intrathecal space.
  
  
  METHODS
  Fifty patients undergoing elective total joint arthroplasty were recruited in this prospective descriptive study. Using a curved-array 2-5 MHz transducer, the lumbar spine was imaged in two views, i.e., longitudinal parasagittal (LP) and transverse midline (TM). The intervertebral levels were identified by counting upwards from the sacrum. The locations of the interlaminar spaces were identified by visualizing the ligamentum flavum-dura mater complex and the posterior aspect of the vertebral body. The needle insertion point for a midline approach was determined from the ultrasound examination and was marked on the skin of the patient's back.
  
  
  RESULTS
  The mean patient age was 67 +/- 10 yr, and 46% of the patients had a body mass index >30 kg . m(-2). Surface landmarks were difficult or impossible to palpate in 38% of the patients. The scan quality on the LP and TM views was adequate or better in 100 and 98% of the patients, respectively. Dural puncture was achieved with one needle insertion attempt and within two needle insertion attempts in 84% and 98% of the patients, respectively. The ultrasound-measured depth to the intrathecal space correlated well with the actual needle insertion depth (concordance correlation coefficient = 0.82, accuracy 0.95, precision 0.86), with a tendency to overestimate the depth by just 2.1 +/- 5.4 mm.
  
  
  CONCLUSIONS
  Ultrasound imaging of the lumbar spine provides clinically useful information that can facilitate spinal anesthesia in the older orthopedic patient population.
authors: Department of Anesthesia, Toronto Western Hospital, 399 Bathurst Street, McL 2-405, Toronto, ON M5T 2S8, Canada. gasgenie@gmail.com
authors: Ki Jinn
authors: KJ
authors: Chin
authors: Anahi
authors: A
authors: Perlas
authors: Mandeep
authors: M
authors: Singh
authors: Cristian
authors: C
authors: Arzola
authors: Arun
authors: A
authors: Prasad
authors: Vincent
authors: V
authors: Chan
authors: Richard
authors: R
authors: Brull
mesh_terms: D000368:Aged; D000775:Anesthesia, Spinal / Q000295:instrumentation / Q000379:methods*; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional