RT Book, Section
A1 Karmakar, Manoj K.
A1 Soh, Edmund
A1 Chee, Victor
A1 Sheah, Kenneth
SR Print(0)
ID 1146854505
T1 Ultrasound Imaging of the Spine: Basic Considerations
T2 Atlas of Sonoanatomy for Regional Anesthesia and Pain Medicine
YR 2018
FD 2018
PB McGraw-Hill Education
PP New York, NY
SN 9780071789349
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1146854505
RD 2024/04/25
AB Ultrasound  has  revolutionized  the  practice  of  regional  anesthesia,  particularly  peripheral  nerve  blockade,  and  it  has  also  been  used  for  central  neuraxial  blocks  (spinal  and  epidural  injections).1–3  However,  the  use  of  ultrasound  for  central  neuraxial  blocks  is  still  in  its  infancy  and  not  as  popular4  as  that  for  peripheral  nerve  blocks.  The  reasons  for  this  are  not  clear,  but  may  be  related  to  the  high  success  rate  of  landmark-based  techniques,  limited  data  on  ultrasound  for  neuraxial  blocks,  perceived  difficulty  in  performing  spinal  sonography,  limited  acoustic  window  for  ultrasound  imaging,  and  poor  understanding  of  spinal  sonoanatomy.  However,  recently  published  data  suggest  that  ultrasound  is  beneficial  for  central  neuraxial  blocks.  Identification  of  a  given  lumbar  intervertebral  level  for  central  neuraxial  block  using  surface  anatomical  landmarks  (Tuffier  line)  is  often  imprecise,5  and  ultrasound  is  more  accurate  than  clinical  assessment.6  It  can  also  be  used  to  accurately  measure  the  depth  to  the  epidural  space  or  thecal  sac7–9  and  predict  the  ease  of  performing  a  neuraxial  block.10  Ultrasound  also  offers  technical  advantage  by  reducing  the  number  of  puncture  attempts,11–14  improves  the  success  rate  of  epidural  access  on  the  first  attempt,12  reduces  the  need  to  puncture  multiple  levels,12–14  and  improves  patient  comfort  during  the  procedure.13  Ultrasound  may  also  be  beneficial  for  central  neuraxial  blocks  in  patients  with  difficult  (ie,  abnormal  or  variant)  spinal  anatomy.15,16  Therefore,  it  is  envisioned  that  the  use  of  ultrasound  for  central  neuraxial  blocks  will  grow  in  the  near  future.  A  sound  knowledge  of  the  anatomy  of  the  spine  is  a  prerequisite  for  understanding  the  sonoanatomy  of  the  spine.  In  this  chapter,  we  describe  general  details  of  spine  anatomy  and  basic  considerations  relevant  for  spinal  sonography  and  central  neuraxial  blocks.