Identification of the epidural space with optical spectroscopy: an in vivo swine study.
BACKGROUND
Accurate identification of the epidural space is critical for safe and effective epidural anesthesia or treatment of acute lumbar radicular pain with epidural steroid injections. The loss-of-resistance technique is commonly used, but it is known to be unreliable. Even when it is performed in conjunction with two-dimensional fluoroscopic guidance, determining when the needle tip enters the epidural space can be challenging. In this swine study, we investigated whether the epidural space can be identified with optical spectroscopy, using a custom needle with optical fibers integrated into the cannula.


METHODS
Insertion of the needle tip into the epidural space was performed with midline and paramedian approaches in a swine. In each insertion, optical spectra were acquired at different insertion depths, and anatomical localization of the needle was determined by three-dimensional imaging with rotational C-arm computed tomography. Optical spectra that included both visible and near-infrared wavelength ranges were processed to derive estimates of the blood and lipid volume fractions.


RESULTS
In all insertions, the transition of the needle tip to the epidural space from an adjacent tissue structure (interspinous ligament or the ligamentum flavum) was found to be associated with an increase in the lipid volume fraction. These increases, which ranged from 1.6- to 3.0-fold, were statistically significant (P = 0.0020). Lipid fractions obtained from the epidural space were 1.9- to 20-fold higher than those obtained from muscle (P = 0.0013). Accidental penetration of an epidural vein during one insertion coincided with a high blood volume fraction.


CONCLUSIONS
The spectroscopic information obtained with the optical spinal needle is complementary to fluoroscopic images, and it could potentially allow for reliable identification of the epidural space during needle placement.
Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA.
James P
JP
Rathmell
Adrien E
AE
Desjardins
Marjolein
M
van der Voort
Benno H W
BH
Hendriks
Rami
R
Nachabe
Stefan
S
Roggeveen
Drazenko
D
Babic
Michael
M
Söderman
Marcus
M
Brynolf
Björn
B
Holmström
D000465:Algorithms; D019412:Anatomy, Cross-Sectional; D000792:Angiography; D000818:Animals; D004824:Epidural Space / Q000033:anatomy & histology* / Q000098:blood supply; D008055:Lipids / Q000737:chemistry; D009339:Needles; D012039:Regional Blood Flow / Q000502:physiology; D019265:Spectroscopy, Near-Infrared; D013057:Spectrum Analysis / Q000379:methods*; D013552:Swine; D014057:Tomography, X-Ray Computed
D008055:Lipids